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Forum Name: Cardiology Diagnostics

Question: T-wave inverson


 austintxtx - Fri Sep 05, 2008 10:36 pm

I am a surgical nurse and I need to find answers to my electrocardiogram showing a T-wave inversion. I am now 34 yrs old, HTN runs in my family at an early age, I am 50lbs overweight, and I have stress(just finished a divorce, little sleep, stressful work environment). I was diagnosed with high blood pressure 01/06(ER visit w/ BP 180/110) and had an EKG showing T-wave inversion. I was not told about this EKG finding. I went to a PCP who did an EKG and it was normal sinus rhythm - no T-wave inverson (in 03/06). I was put on propanolol 80mg/day.

My next EKG was 12/06 at the hospital, when I passed out at work from very high blood pressure (170/110). An EKG was done, and showed a T-wave inversion, the same as my previous hospital EKG, so nothing was said. My PCP then prescribed me to divide my meds to take twice a day, and so far, it appears to have solve my HTN issues.

Two weeks ago, while driving home from Houston, under no physical stress, I developed certain, noticible chest pain. The pain was midline, under the sternum, and was about a 7 out of 10 on the pain scale. I have never had pain like this and was constant for the next 24hours . It slowly disappated over the next 4 days. It did not change or move and it was very uncomfortable, hard to decribe, except that it hurt pretty bad. I went to my doctor the next afternoon and the EKG showed a T-wave inversion, a different result from the previous EKG in the office showing NSR in 03/06.

He wanted me to have a Thalium stress test done. I went ahead and consulted a local cardiologist and I am now scheduled for a nuclear stress test.

My question is: What medical issues could be the cause of the T-wave inversion, given my medical history and what are the possible outcomes of my situation(how serious is it).

Thank you for your comments.
 John Kenyon, CNA - Mon Oct 06, 2008 10:15 pm

User avatar Hello -

Inverted T-waves are often a cause of much consternation, and at least half the time they don't signify anything serious. However, you have enough risk factors to warrant the stress test, and that's a great idea. I'm happy you'll be doing that and look forward to hearing how it turns out.

It is possible you have some early coronary artery disease. With the symptoms you experienced the one time, plus the markedly elevated BP, overweight, and an EKG abnormality, it is possible the T-wave inversion signified some intermittent ischemia, and if this is the case you're going to want to know about it so as to take the necessary steps to avoid damage and mitigate any disease.

You also may not have any disease. The chest pain was in the appropriate location to be at least suspect, but the fact that it was so severe and localized makes me wonder if it wasn't due to something else. There is, of course, no way of knowing for certain, but most substernal pain due to cardiac causes is usually described as dull, as pressure, and not generally severe in nature. Once notable exception to this rule is when the pain is due to coronary artery spasm, but that doesn't usually last more than 15-20 minutes. And before I go any further, I would urge you, should this happen again, to no allow it to go on for 24 hours, or even 24 minutes, but maybe 5 at the most, before you get yourself to an ER. For one thing, it would be easier to rule out heart-related issues. Of course the flip side of that is that it could also be life-saving. Please don't play the odds on this sort of thing. You do, after all, have a couple risk factors, and women actually do sometimes develop heart disease young.

Did the T-wave inversion occur in all leads or just a few? Can you relate which ones? Also, do you know if the inversion was deep or just flipped? These things are significant. Often stress itself, dehydration, low potassium and a few other factors can cause flipped T-waves. So can ischemia, but in the absence of risk factors and symptoms, it is a less likely cause.

While we can discuss what might be going on, the only sure way to find out is for you to have that stress test. Please follow up with us here afterward, if you don't mind. Hopefully it comes out negative, but if there is something more going on, you'll need to know that too. I'll look forward to hearing more. Best of luck to you.

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