Differential Diagnosis for Inverted T Waves on Leads 1, aVL, V4, V5, V6 with Emergency Hypertension
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): Inverted T waves in these leads, particularly in the context of emergency hypertension, strongly suggest myocardial ischemia or infarction, which is a medical emergency. The distribution of T wave inversions across these leads indicates involvement of the lateral and possibly anterior walls of the heart.
Other Likely Diagnoses
- Hypertensive Heart Disease: Severe hypertension can lead to left ventricular hypertrophy and strain, manifesting as T wave inversions on the ECG. The presence of emergency hypertension alongside these ECG changes supports this diagnosis.
- Left Ventricular Hypertrophy (LVH): Often associated with hypertension, LVH can cause T wave inversions due to the increased thickness of the left ventricular wall, which alters the electrical activity of the heart.
- Myocarditis: Inflammation of the heart muscle can lead to various ECG abnormalities, including T wave inversions. While less common, it's a consideration, especially if there's a recent history of viral illness or other inflammatory conditions.
Do Not Miss Diagnoses
- Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that can present with severe hypertension and ECG changes, including T wave inversions. The pain and hypertension associated with aortic dissection can mimic ACS, making it a critical diagnosis not to miss.
- Pulmonary Embolism (PE): A large PE can cause acute right ventricular strain, leading to ECG changes, including T wave inversions in various leads. The presence of emergency hypertension might not be as directly related but could be part of the clinical picture in severe cases.
Rare Diagnoses
- Cardiac Sarcoidosis: A condition where granulomas form in the heart, potentially leading to various ECG abnormalities, including T wave inversions. It's less common and might not be the first consideration but should be kept in mind, especially if other diagnoses are ruled out.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Primarily affects the right ventricle but can lead to ECG changes, including T wave inversions, in the context of significant disease. It's rare and typically presents with arrhythmic symptoms rather than acute hypertension.