Supreeti Behuria, Justin A. Ratcliffe, Harry Fischer and Paul Schweitzer
T wave inversions on an electrocardiogram (EKG) can manifest from any process that result in a relative delay in regional ventricular repolarization. The differential diagnosis of right precordial T wave inversions, leads V1-V3, include myocardial ischemia, a normal athlete’s heart, arrhythmogenic right ventricular dysplasia, and pulmonary embolism amongst others. The case discussed below is of a 73 year old man who presented to a cardiologist with chest pain and shortness of breath. He had an initial ECG that showed a normal sinus rhythm with T wave inversions across the right precordial leads. He had an unrevealing coronary angiogram and an echocardiogram that only showed right-sided strain. Thereafter, he had a ventilation perfusion scan, which diagnosed pulmonary embolus. He was treated with anticoagulation and his symptoms resolved. The present case delineates the importance of recognizing this ECG pattern and, in the correct clinical setting, can facilitate in diagnosis and treatment of a relatively common medical condition.
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