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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.
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