T wave inversion

[cb]

I'm a 41 year old woman with no prior history of heart disease. I started having some left back and shoulder pain when walking around 6 months ago. I do have problems in my left arm that could lead to muscle pain, but given my strong family history of heart disease, Idecided to have it checked out.

I had a stress echo done today, and while the doctor said the echo was normal, he mentioned that I have an abnormal ekg pattern - inverted t waves. He was rather causal when mentioning this (flippant, even) saying it was nothing to worry given the normal echocardiogram.

I want to believe him, but he was not very helpful in understanding what it all meant.

Any insight into what this means for me now or in the future?

[Theresa Jones, RN]

Hi cb,
The T wave on an EKG represents the repolarization or resetting of the electrical cells in the bottom chambers of the heart. Reasons for inverted T waves are numerous and may include ischemia, heart attack, hyperventilation, anxiety, certain medications, infections around the heart, pulmonary embolus (blood clot in the lung), electrolyte disturbance (abnormalities in sodium, potassium levels) etc. When an EKG is viewed, all of the waves are evaluated, not just one in particular. With this in mind and considering that the rest of the waves on the EKG appeared to him/her without any sort of defect, is probably why he/she stated it was an essentially normal EKG. It was quite wise of you to have this checked out considering your family history and you should continue to have physical exams regularly. I hope this was helpful.
Sincerely,
Rntdj

[cb]

Thank you for your quick response. Would anxiety due to having the test be enough to cause the inversion, or would it have to be more chronic anxiety? I have to say, going in for a cardiac stress test did put me on edge a bit!

[Theresa Jones, RN]

Hi cb,
Considerable amounts of stress or anxiety affects people in different ways so it would not be impossible. Again, in my opinion, when the overall EKG was viewed, since it demonstrated no other abnormalities I would consider that's why there wasn't an extreme concern.
Sincerely,
Rntdj

[Dr. Yasser Mokhtar]

Dear cb,

What kind of a stress echo was it? Was it an exercise echo or a dobutamine echo or other chemical stress? And if it was an exercise echo, how long did you go on the treadmill and did you reach your predicted maximum heart rate for your age? If it was a dobutamine stress, did you reach your heart rate as well? Did you have any chest pain during the stress test whether exercise or otherwise? Did you have high blood pressure during the stress test?

Inverted t-waves are not specific for diagnosis of ischemia like Theresa mentioned and they can be caused by a slue of other things. A more specific thing would be st segment changes during exercise. The ekg stress test even is not that good alone (especially in women) but when an echo or a nuclear study is added to the ekg results, either increase the sensitivity and the specificity of the ekg. With the echo, it is even better, because if there is ischemia, it causes changes in the way the heart contracts that are seen in real time with the naked eye on the spot but the problem is that the patient is usually hyperventilating and it is not easy sometimes to get good views on a patient who was running but with the dobutamine echo, this problem is not there.

If this was an exercise stress test and you reached an advanced stage on the treadmill like state 3 or so and you did not have chest pain, there is no need to worry whatsoever, because this is a normal stress test which has been confirmed with the normal echo.

There is nothing 100% perfect except to see the coronaries and this is done via coronary angiography but in your case this is not needed.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

[cb]

Thank you so much for your reply.

It was a stress echo. I was on the treadmill for 11 minutes and reached my targeted heart rate of 180. The t-wave inversion was seen prior to exercise and, I'm assuming, during. As far as I know my bp did not rise significantly (tends to run around 100/60) and I had no pain during the test. My heart rate fell quickly, so time for the echo was limited, but he said results were normal.

At this point I'm going to assume the abnormality is from anxiety and is nothing to worry about.

Thank you for you help!

[Dr. Yasser Mokhtar]

Dear cb,

Thank you very much for the update.

Going on the treadmill for 11 minutes means that you have a very good aerobic capacity. Your heart rate falling fast means that you are physically fit. No having chest pain and reaching your maximum predicted heart rate for your age means that your heart was maximally stressed and at maximal stress, your coronary flow is excellent as you did not have any chest pain.

There is nothing to worry about regarding this t-wave inversion. One more thing, iIf you had a hyperventillation phase before the test and this was when t-wave inversions were seen, this is a normal finding and you don't have to worry about that.

Don't assume that it is due to stress or due to anything else, you have a normal heart and ekgs are not the best evaluators of one's heart otherwise, there would not be all those other sophisticated ways of assessing the heart such as echo and coronary angiograms amongst many others.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.