Left or Right? When Diffuse T-Wave Inversion Is Worse Than Coronary Ischemia

      Chest pain associated with new diffuse T-wave inversion in the electrocardiogram (ECG) is an alarming presentation, but it is not always associated with coronary ischemia. A 41-year-old man with sickle cell disease was hospitalized for a 1-day history of vomiting, diarrhea, and abdominal pain. He also described bilateral hip pain consistent with prior sickle cell crises. In addition, he reported nonexertional substernal chest pain that was not typical for his sickle cell disease. A 12-lead ECG demonstrated sinus rhythm with negative T-waves both in the inferior and in the anterolateral leads (Figure 1). The diffuse T-wave inversion was new compared to an ECG recorded a year before (Figure 2).
      Figure 1
      Figure 1Electrocardiogram on presentation demonstrated diffuse T-wave inversion both in the inferior and in the precordial leads. Additional findings, however, pointed to a right-sided heart problem, rather than left-sided heart problem. See text.
      Figure 2
      Figure 2Electrocardiogram from 1 year before was near normal.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kaplan JD
        • Evans Jr, GT
        • Foster E
        • Lim D
        • Schiller NB
        Evaluation of electrocardiographic criteria for right atrial enlargement by quantitative two-dimensional echocardiography.
        J Am Coll Cardiol. 1994; 23: 747-752
        • Kopeć G
        • Tyrka A
        • Miszalski-Jamka T
        • et al.
        Electrocardiogram for the diagnosis of right ventricular hypertrophy and dilatation in idiopathic pulmonary arterial hypertension.
        Circ J. 2012; 76: 1744-1749
      1. Kashou AH, Basit H, Chhabra L. Electrical axis (normal, right axis deviation, and left axis deviation) [Updated June 29, 2019]. Available from: February 7, 2020.

        • Waligóra M
        • Kopeć G
        • Jonas K
        • et al.
        Mechanism and prognostic role of qR in V1 in patients with pulmonary arterial hypertension.
        J Electrocardiol. 2017; 50: 476-483
        • Bossone E
        • Paciocco G
        • Iarussi D
        • et al.
        The prognostic role of the ECG in primary pulmonary hypertension.
        Chest. 2002; 121: 513-518
        • Tonelli AR
        • Baumgartner M
        • Alkukhun L
        • Minai OA
        • Dweik RA
        Electrocardiography at diagnosis and close to the time of death in pulmonary arterial hypertension.
        Ann Noninvasive Electrocardiol. 2014; 19: 258-265
        • Ataga KI
        • Sood N
        • De Gent G
        • et al.
        Pulmonary hypertension in sickle cell disease.
        Am J Med. 2004; 117: 665-669
        • Colle IO
        • Moreau R
        • Godinho E
        • et al.
        Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study.
        Hepatology. 2003; 37: 401-409
        • Castro O
        • Hoque M
        • Brown BD
        Pulmonary hypertension in sickle cell disease: cardiac catheterization results and survival.
        Blood. 2003; 101: 1257-1261
        • Hayes MM
        • Vedamurthy A
        • George G
        • et al.
        Pulmonary hypertension in sickle cell disease.
        Ann Am Thorac Soc. 2014; 11: 1488-1489
        • Fisher MR
        • Forfia PR
        • Chamera E
        • et al.
        Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension.
        Am J Respir Crit Care Med. 2009; 179: 615-621