Differential Diagnosis for New T Wave Inversion on EKG
- Single Most Likely Diagnosis
- Ischemic heart disease: This is the most common cause of new T wave inversion, often indicating myocardial ischemia or infarction. The T wave inversion can be a sign of coronary artery disease, especially if it occurs in the context of chest pain or other symptoms suggestive of ischemia.
- Other Likely Diagnoses
- Hypokalemia: Low potassium levels can cause T wave inversion, among other EKG changes. This is a common and easily treatable condition that can cause significant cardiac symptoms if not addressed.
- Hypertrophic cardiomyopathy: This condition, characterized by thickening of the heart muscle, can lead to T wave inversion, particularly in the anterior leads. It's a significant cause of sudden cardiac death in young athletes.
- Pulmonary embolism: While not as common as other causes, pulmonary embolism can lead to T wave inversion, especially in the anterior leads (V1-V4), as part of the classic S1Q3T3 pattern, although this pattern is not highly sensitive.
- Do Not Miss Diagnoses
- Acute coronary syndrome (ACS), including myocardial infarction: Although included under ischemic heart disease, it's crucial to emphasize that any new T wave inversion, especially if associated with symptoms like chest pain, shortness of breath, or if the inversion is deep or widespread, necessitates immediate evaluation for ACS.
- Cardiac tamponade: While T wave inversion is not a specific sign of tamponade, the condition can lead to low voltage QRS complexes and electrical alternans. The clinical context (e.g., hypotension, jugular venous distension) is key to suspecting tamponade.
- Rare Diagnoses
- 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 inversion in the right precordial leads.
- Myocarditis: Inflammation of the heart muscle can cause various EKG abnormalities, including T wave inversion, although this is not a specific finding.
- Central nervous system (CNS) events: Rarely, CNS events like subarachnoid hemorrhage can cause deep, inverted T waves due to the intense sympathetic surge (Catecholaminergic effect).