title: Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature.
abstract: OBJECTIVE
  To describe the electrocardiographic (ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis.
  
  
  METHODS
  A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT (QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality non-invasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.
  
  
  RESULTS
  Eight adult subjects (5 females) with a mean age of 66 years (range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval (639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion (≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3 (5 ×). In 3 patients presented with mild T-wave inversion (patients 1, 5 and 4 mm), the QTc interval was not prolonged (432, 409 and 424 msec), respectively.
  
  
  CONCLUSIONS
  T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.
authors.affiliation: Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands.
authors.forename: Salah Am
authors.initials: SA
authors.lastname: Said
authors.affiliation: Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands.
authors.forename: Rene
authors.initials: R
authors.lastname: Bloo
authors.affiliation: Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands.
authors.forename: Ramon
authors.initials: R
authors.lastname: de Nooijer
authors.affiliation: Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands.
authors.forename: Andries
authors.initials: A
authors.lastname: Slootweg
keywords: Coronary angiography; Differential diagnosis; Magnetic resonance imaging; Pulmonary computed tomography angiography; T-wave inversion