T wave inversion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: negative T wave; negative T waves; inverted Ts;flipped T waves; flipped T wave; flipped Ts


T wave inversion is a non-specific electrocardiographic sign in which the T wave, an electrical signal that occurs when the heart is repolarizing or recharging itself, it is upside down instead of upright.


Primary T Wave Inversion

These changes in the T wave represent a primary abnormality in electrical repolarization (i.e. they are not due to or secondary to a change in conduction). Examples include the dig effect, myocardial ischemia or central nervous system events such as subarachnoid hemorrhage.

Secondary T Wave Inversion

The T wave may be inverted as a result of changes in the sequence of ventricualr activation such as is seen with premature ventricular contractions (PVCs), left bundle branch block, right bundle branch block (RBBB) and pre excitation syndromes like WPW.


Causes by Organ System

Cardiovascular Acute pericarditis, Advanvced AV block, Angina, Arrhythmogenic right ventricular dysplasia, Atrioventricular reentry tachycardia with orthodromic conduction, Bundle branch block, Global T-wave inversion, Hypertrophic cardiomyopathy, Memory T-wave phenomenon, Myocardial infarction, Myocardial ischemia, Myocarditis, Persistent juvenile T-wave pattern, Pre-excitation syndrome, Pulmonary embolism, Restrictive cardiomyopathy, Stress cardiomyopathy, Takotsubo cardiomyopathy, Ventricular ectopic beats, Ventricular hypertrophy with strain, Wellens' syndrome, WPW syndrome, Brugada syndrome
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cocaine, Digitalis, Digoxin
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Brugada syndrome
Hematologic Anemia
Iatrogenic After surgery, Ventricular paced beats
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic Cerebrovascular accident, Intracranial hemorrhage, Raised intracranial pressure, Status epilepticus
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Cocaine, Digitalis, Digoxin
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Electrolyte abnormalities, Hypokalemia
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Cocaine, After meals, Fever, Hyperventilation, Lead aVR of normal ECG, Normal finding in children, Normal variant of repolarization, Standing

Causes in Alphabetical Order