The differential diagnosis for T-wave inversions is broad and includes, but is not limited to: ischemia, hypertrophy, bundle branch blocks, early repolarization variants, persistent juvenille T wave pattern, cardiac memory, electrolyte disturbances like hypokalemia, and increased intracranial pressure.
T-wave Inversions
![twi@2x](https://www.ecgstampede.com/wp-content/uploads/2022/11/twi@2x.png)
Examples
![ECG Showing T-wave Inversions](https://www.ecgstampede.com/wp-content/uploads/2022/11/48-Ischemic-TWI.jpg)
T-wave Inversions
The symmetric morphology of the T wave inversions seen in I, aVL, and V2 (biphasic with negative terminal deflection) suggest ischemia. Left heart catheterization revealed 95% mid-left anterior descending artery stenosis.![ECG Showing T-wave Inversions](https://www.ecgstampede.com/wp-content/uploads/2022/11/52-Dynamic-TW_3.jpg)
T-wave Inversions
Left heart catheterization revealed 99% proximal left anterior descending artery stenosis.![ECG Showing T-wave Inversions](https://www.ecgstampede.com/wp-content/uploads/2022/11/52-Dynamic-TW_4.jpg)
T-wave Inversions
Left heart catheterization revealed 99% proximal left anterior descending artery stenosis.![ECG Showing T-wave Inversions](https://www.ecgstampede.com/wp-content/uploads/2022/11/67-HyperacuteTWaves_spPCI_D2.jpg)
T-wave Inversions
The repolarization abnormalities seen here represent "reperfusion T waves." This ECG was performed immediately after percutaneous coronary intervention of the left anterior descending artery. Reperfusion T waves are expected repolarization changes associated with reperfusion. They can be seen, also, with unstable lesions representing ischemia (i.e., Wellens syndrome).![ECG Showing Hypertrophic Cardiomyopathy](https://www.ecgstampede.com/wp-content/uploads/2022/11/105-HCM-1-scaled.jpg)
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy can have a variable appearance and it's not uncommon to see repolarization abnormalities like the ones seen here.![ECG Showing Wellens Syndrome](https://www.ecgstampede.com/wp-content/uploads/2022/11/106-Wellens.jpg)
Wellens Syndrome
This is type B Wellens pattern with deeply inverted precordial T waves. This patient had a 95% proximal left anterior descending stenosis.![ECG Showing Wellens Syndrome](https://www.ecgstampede.com/wp-content/uploads/2022/11/109-Wellens.jpg)
Wellens Syndrome
This is a type A Wellens pattern with biphasic T waves that have negative terminal deflections. This patient had a 90% proximal left anterior descending artery stenosis.![ECG Showing Hypertrophic Cardiomyopathy](https://www.ecgstampede.com/wp-content/uploads/2022/11/116-ApicalHCM-1-scaled.jpg)
Hypertrophic Cardiomyopathy
This patient had known apical hypertrophic cardiomyopathy.![ECG Showing Left Ventricular Hypertrophy](https://www.ecgstampede.com/wp-content/uploads/2022/11/84-LVH-1-scaled.jpg)
Left Ventricular Hypertrophy
Classic findings of left ventricular hypertrophy including large amplitude QRS complexes and associated repolarization abnormalities (e.g., asymmetric T-wave inversion in V6).![ECG Showing Left Ventricular Hypertrophy](https://www.ecgstampede.com/wp-content/uploads/2022/11/36-LVH-RAD-RAE-2-scaled.jpg)