Differential Diagnosis for T Wave Inversion in Lead 3 and AVF
Single Most Likely Diagnosis
- Ischemic Heart Disease: T wave inversion in the inferior leads (III and aVF) is a common finding in ischemic heart disease, particularly in the context of coronary artery disease affecting the right coronary artery, which supplies the inferior wall of the heart.
Other Likely Diagnoses
- Inferior Myocardial Infarction: While often associated with Q waves, inferior MI can also present with T wave inversion in leads III and aVF, especially in the subacute or chronic phase.
- Cardiac Hypertrophy: Right ventricular hypertrophy can cause T wave inversion in the inferior leads due to the altered electrical activity of the heart.
- Pulmonary Embolism: Large pulmonary emboli can cause strain on the right ventricle, leading to T wave inversion in the inferior leads among other ECG changes.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although mentioned under ischemic heart disease, it's crucial to emphasize that any sign of ischemia or infarction, such as T wave inversion in leads III and aVF, could indicate an ACS, which requires immediate medical attention.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition but one that can lead to life-threatening arrhythmias. T wave inversion in the right precordial leads is more typical, but inferior lead involvement can occur.
Rare Diagnoses
- Brugada Syndrome: Typically characterized by ST elevation in leads V1-V3, but some variants can present with T wave inversion in the inferior leads.
- Hypokalemia: Severe potassium deficiency can cause various ECG abnormalities, including T wave inversion, although this is less specific to leads III and aVF.
- Digitalis Effect: Patients on digitalis (digoxin) can exhibit a variety of ECG changes, including T wave inversion, due to the drug's effect on the heart's electrical conduction system.