From the Guidelines
T wave inversion in young people is most commonly caused by benign factors, but can also be a sign of underlying cardiomyopathy or other cardiac conditions, and therefore requires careful evaluation and consideration of clinical context, as recommended by the most recent guidelines 1. When evaluating T wave inversions in young people, it is essential to consider the clinical context, including symptoms, family history, and physical examination findings.
- Benign causes of T wave inversion in young people include:
- Juvenile T wave pattern, which typically resolves with age and requires no treatment
- Athlete's heart, where cardiac remodeling from intense exercise leads to ECG changes
- Persistent juvenile pattern, which can remain into adulthood without clinical significance
- More concerning causes of T wave inversion in young people include:
- Hypertrophic cardiomyopathy
- Arrhythmogenic right ventricular cardiomyopathy
- Myocarditis
- Coronary artery anomalies
- Wolff-Parkinson-White syndrome According to the international recommendations for electrocardiographic interpretation in athletes, T wave inversion in the lateral or inferolateral leads may indicate hypertrophic cardiomyopathy, dilated cardiomyopathy, or left ventricular non-compaction, and requires further evaluation with echocardiography or cardiac MRI 1. In asymptomatic individuals with isolated T wave inversions and no family history of sudden cardiac death, observation may be sufficient, but those with concerning features require referral to a cardiologist for comprehensive evaluation, as recommended by the guidelines 1. The presence of T-wave inversion in two or more adjacent leads in an athlete is a non-specific warning sign of a potential cardiovascular disease at risk of sudden cardiac death during sports, and requires further evaluation, as stated in the European Heart Journal study 1. In young athletes, T wave inversion beyond V1 may reflect an underlying congenital heart disease leading to a right ventricular volume or pressure overload state, arrhythmogenic right ventricular cardiomyopathy, or an inherited ion-channel disease, and deserves special consideration, as noted in the European Heart Journal study 1.
From the Research
Causes of T Wave Inversion in Young People
- T wave inversion (TWI) in young people can be caused by various factors, including physiological adaptations and pathological conditions 2.
- Physiological adaptations such as the juvenile pattern and training-induced repolarization variants can lead to TWI in athletes 2, 3.
- Pathological conditions like cardiomyopathies, ion channel diseases, and other cardiac abnormalities can also cause TWI in young people 2, 4.
- Anterior T-wave inversion (ATWI) is more common in women and athletes, and is often confined to leads V1 to V2, which may be a normal variant or physiological phenomenon in asymptomatic white individuals 4.
- TWI beyond V2 is rare, particularly in men, and may warrant investigation for underlying cardiac disease 4.
- Other causes of TWI in young people may include cardiac memory, a phenomenon where the T wave tracks the preceding abnormal QRS complex, and neurogenic myocardial stunning, which can occur in response to mental stress 5, 6.