Chest pain and T-wave inversion in lead V2
This is the ECG of a young man who complained of chest pain.Here is the computer interpretation:ATRIAL FLUTTER/TACHYCARDIA(this is obviously incorrect)LEFT POSTERIOR FASCICULAR BLOCK [QRS AXIS greater than 109, INFERIOR Q]MODERATE ST DEPRESSION [0.05+ mV ST DEPRESSION]ABNORMAL ECGI saw the ECG before seeing the patient, indeed before he was even in his room. I immediately saw that the computer was incorrect, but I found 2 abnormalities. What are they? I showed this to several physicians. They were worried about the T-wave inversion in V2.One mentioned " Wellens ' waves "Another asked: " Are these juvenile T-waves? " (very good question!)For more on this: Persistent Juvenile T-wave PatternWhat do you think?I keep getting response tweets that T-wave inversion in V2 is normal. It is not normal. It is not necessarily pathologic, but it is not normal. It occurs normally in approximately 1% of males over age 14 but younger than 30. It is common in young women (these are the typical juvenile T-waves, link to relevant post above).T-wave inversion in V2 occurs in many pathologies, including posterior MI, pulmonary embolism, Wellens ' syndrome. It is one of the minor criteria for arrhythmogenic right ventricular dysplasia ( "Minor: Inverted T-waves in right precordial leads V1-V2 " )Here is my list of Normal and Pathologic T-wave inversion:• Normal t wave vector is leftward, inferior and anterior.• T waves sho...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs
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