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

Overview

T wave inversion is a non-specific electrocardiographic sign.

Classification

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 ventricualr contracts (PVCs), left bundle branch block, right bundle branch block (RBBB) and pre excitation syndromes.

Causes

• Electrolyte disturbance
• Ischemic heart disease
• Left bundle branch block, it is normal for the T wave to be inverted if the QRS complex is upright
• Left ventricular hypertrophy with strain
• Myocarditis
• Pulmonary embolism, particularly in the anterior precordium
• Restrictive cardiomyopathy

Post Pubertal Male Athlete

• Arrhythmogenic RV dysplasia should be suspected in this cohort if the T wave inversion persists beyond lead V₁.