Ischemic Heart Disease: T wave inversion in these leads can indicate myocardial ischemia, particularly in the context of chest pain or other symptoms suggestive of coronary artery disease. The distribution of T wave inversion across leads II, III, and V1-4 may suggest involvement of the right coronary artery or left anterior descending artery.

Hypertrophic Cardiomyopathy: This condition can cause T wave inversion due to asymmetric septal hypertrophy, which may lead to abnormal repolarization patterns.
Pulmonary Embolism: While more commonly associated with T wave inversion in leads V1-4, pulmonary embolism can also cause T wave inversion in the inferior leads (II, III) due to right ventricular strain.
Cardiac Amyloidosis: This condition can lead to diffuse T wave inversion due to the deposition of amyloid fibrils in the myocardium, affecting repolarization.

Acute Coronary Syndrome (ACS): Including myocardial infarction, which requires immediate attention. T wave inversion can be a sign of ischemia or infarction, especially if accompanied by symptoms like chest pain.
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A condition that affects the right ventricle and can cause T wave inversion in leads V1-4, potentially leading to life-threatening arrhythmias.
Brugada Syndrome: Characterized by T wave inversion in leads V1-3, which can be a marker for increased risk of sudden cardiac death due to ventricular fibrillation.

Myocardial Bridging: A condition where a portion of a coronary artery dives into and is surrounded by myocardium, which can cause ischemia and T wave inversion.
Left Ventricular Non-Compaction: A rare cardiomyopathy characterized by a spongy appearance of the left ventricle, which can lead to abnormal repolarization and T wave inversion.
Sarcoidosis: A systemic disease that can affect the heart, leading to granulomatous infiltration and potential for T wave inversion among other ECG abnormalities.