Differential Diagnosis for T Wave Depressions in V1 and V2
Single Most Likely Diagnosis
- Ischemic Heart Disease: T wave depressions in leads V1 and V2 are often indicative of myocardial ischemia, particularly in the context of coronary artery disease affecting the anterior wall of the heart. This pattern can be seen in patients with stable angina or during acute coronary syndromes.
Other Likely Diagnoses
- Hypokalemia: Low potassium levels can cause T wave depressions, among other ECG changes. The effect is often more pronounced in the precordial leads, making it a plausible explanation for T wave depressions in V1 and V2.
- Left Ventricular Hypertrophy (LVH): LVH can lead to T wave abnormalities, including depressions, particularly in the lateral and anterior leads. The strain pattern associated with LVH can manifest as T wave inversions or depressions in these leads.
- Anterior Cardiac Strain Pattern: This can be seen in conditions causing increased pressure or volume overload on the left ventricle, leading to T wave changes as a result of myocardial strain.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although mentioned under ischemic heart disease, it's crucial to emphasize that any sign of ischemia, including T wave depressions in V1 and V2, could be indicative of an ACS, which requires immediate medical attention.
- Pulmonary Embolism: While less common, pulmonary embolism can cause T wave inversions in the anterior leads due to the strain it puts on the right ventricle, which can indirectly affect the left ventricle and cause ECG changes.
Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This condition can lead to T wave inversions in the right precordial leads (V1-V3) due to the replacement of myocardial tissue with fibrofatty tissue, primarily in the right ventricle.
- Myocarditis: Inflammation of the myocardium can cause various ECG abnormalities, including T wave depressions or inversions, depending on the extent and location of the inflammation.
- Cardiac Sarcoidosis: This condition can lead to granulomatous infiltration of the myocardium, potentially causing scarring and leading to various ECG abnormalities, including T wave changes in any lead, depending on the areas of the heart affected.