Differential Diagnosis for Inverted T Wave in Lead 2,3,5,6
Single Most Likely Diagnosis
- Ischemic Heart Disease: This is often the first consideration for inverted T waves in the leads mentioned, as it can indicate myocardial ischemia or infarction, particularly in the context of chest pain or other symptoms suggestive of cardiac ischemia.
Other Likely Diagnoses
- Left Ventricular Hypertrophy (LVH): Inverted T waves can be seen in LVH, especially if there is associated strain pattern. This condition is characterized by thickening of the left ventricle wall, often due to hypertension.
- Bundle Branch Blocks: Both left and right bundle branch blocks can cause alterations in T wave morphology, including inversion, due to the abnormal ventricular depolarization.
- Cardiomyopathies: Various cardiomyopathies, such as hypertrophic cardiomyopathy, can lead to T wave inversions due to the abnormal structure and function of the heart muscle.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less common, pulmonary embolism can cause T wave inversions, particularly in the anterior leads (V1-V4), but can also affect other leads. It's a critical diagnosis to consider due to its high mortality if untreated.
- Cardiac Tamponade: This condition, characterized by fluid accumulation in the pericardial sac, can lead to electrocardiographic changes including T wave inversions. It's a medical emergency requiring prompt intervention.
Rare Diagnoses
- Myocarditis: Inflammation of the heart muscle can lead to various electrocardiographic abnormalities, including T wave inversions. It's less common but should be considered, especially in the appropriate clinical context.
- Hypokalemia: Severe potassium deficiency can cause T wave flattening or inversion, among other electrocardiographic changes. While not the first diagnosis to consider for isolated T wave inversions, it's an important condition to recognize due to its potential to cause serious cardiac arrhythmias.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition characterized by replacement of the right ventricular muscle with fibrofatty tissue, leading to arrhythmias and potentially T wave inversions, especially in the right precordial leads.