A 60 year old patient with large T-wave inversions

Written by Andrus Alian and Pendell Meyers, with edits by Steve SmithA female in her 60s with history of stage IV lung cancer presented to the ED with 3/10 chest pain and dyspnea waxing and waning for the last 24 hours. She had no personal or family history of coronary artery disease, drug use, HTN, or dyslipidemia. She did have a history of smoking. She recently had a 2 hour flight. She denied diaphoresis, nausea, or back pain. Vital signs were stable and she was afebrile.Here is her initial ECG (during persistent 3/10 active chest pain):Large T-wave inversions. What is their distribution? What is distinctive about them? What do they mean?Here is her baseline ECG for comparison:Basically normal.Interpretation of presentation ECG:This is likely a junctional rhythm or (less likely) a very low ectopic atrial rhythm, as the P-wave is awkwardly close to the QRS complex and has unusual morphology unlike normal P-waves. This is confirmed to be different from her baseline sinus rhythm P-waves.There are very large, symmetric, whole T-wave inversions in II, III, aVF, and V3-V6. The computerized QT and QTc were 446 and 530 ms.The differentialin general fornew T-wave inversions in both the inferior and anterior leads simultaneously (not the differential for this ECG in particular) is important and unique: Baseline abnormality - the T-waves in this case are too abnormal to be possibly present at baseline, but smaller less dramatic T-wave inversions could be baselineRe...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs