Differential Diagnosis for Non-Specific T Wave Abnormality
Single Most Likely Diagnosis
- Ischemic Heart Disease: This is the most likely diagnosis given the initial presence of inverted T waves in inferior leads, which is a common sign of myocardial ischemia. The progression to non-specific T wave abnormalities in both inferior and anterior leads may indicate a more widespread or evolving ischemic process.
Other Likely Diagnoses
- Hypokalemia: Electrolyte imbalances, particularly hypokalemia, can cause non-specific T wave abnormalities. The changes in T wave morphology could be due to fluctuations in potassium levels.
- Left Ventricular Hypertrophy (LVH): LVH can lead to T wave abnormalities due to the increased thickness of the left ventricular wall, which can alter the electrical activity of the heart.
- Cardiac Repolarization Abnormalities: Conditions affecting the repolarization phase of the cardiac cycle, such as long QT syndrome, can manifest with non-specific T wave changes.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although the ECG changes are non-specific, the history of inverted T waves followed by a change in T wave morphology could be indicative of an ACS, such as a non-ST elevation myocardial infarction (NSTEMI). Missing this diagnosis could be catastrophic.
- Cardiac Arrhythmias: Certain arrhythmias, like atrial fibrillation with rapid ventricular response, can cause non-specific T wave changes. Identifying and treating the underlying arrhythmia is crucial.
Rare Diagnoses
- Myocarditis: Inflammation of the myocardium can lead to non-specific ECG changes, including T wave abnormalities. This diagnosis is less common but should be considered, especially in the context of systemic illness or recent viral infection.
- Cardiac Sarcoidosis: This condition, characterized by granulomatous infiltration of the heart, can cause a variety of ECG abnormalities, including non-specific T wave changes. It is a rare but important consideration in the differential diagnosis.