Anterior T wave inversion due to Pulmonary Embolism
Posted Mar 29 2010 5:59pm
A 32 year old male presented with a 4 day history of dyspnea, cough, palpitations, and chest pain. He had an ECG done immediately (shown above). This showed anterior T wave inversions, a QTc of 431, and also T inversion in lead III. There is sinus tachycardia and an S1Q3T3. This is all highly suspicous for pulmonary embolism.
Oxygen saturation was 95%, there were some end expiratory wheezes. D dimer was 3000. A CT pulmonary angio confirmed large central PE.
Kosuge et al. (Am J Cardiol 2007;99:817-821) compared patients with ACS and PE who had precordial T wave inversions in V1-V4. They found that in this select population, negative T waves were observed in only 15 of patient with ACS compared with 88% of patients with Acute PE.
It is tempting to diagnose Wellens' syndrome with anterior T wave inversions, but Wellens' T waves simply look different, should have a longer QTc, generally don't extend out to V6, and, most importantly, don't have T inversion in lead III.
Of course the clinical scenario is most important.