Inverted T Wave

[bluecrimson]

I am a 29 year old male with no history of heart problems or disease.  During my annual physical my ekg revealed inverted t waves.  In previous years this my ekg was "normal" and unchanged.  About two weeks before the physical I had been ill with a fairly high fever - over 102 for 3 days and peaking at 103.7.  As a result of the ekg my doctor sent me for a nuclear stress test and a cardiac echo.  Both of these tests were "normal" although the inverted t waves persist.  During the stress test, the t waves were inverted although they did not vary - which I was told was good.  The cardiologist who was present for the stress test suggested that if the nuclear portion came back normal and the echo was normal that additional tests would need to be run in order to try and determine why the t waves had inverted.  My primary care doctor does not seem inclined to have additional tests performed.  Everyone agrees it is possible that my recent illness caused the t wave inversion.  In this situation would additional tests normally be prescribed - and if so what would they be?  Also, what does it mean to have inverted t waves and if my recent illness was the cause, could they revert to normal?  Thanks in advance for your help.

[CCF-M.D.-KE]

Dear bluecrimson,

In the setting of a normal echocardiogram and nuclear stress test the likelihood of the inverted T-waves representing something serious is quite low.  It is possible that the T-wave inversions are related to your recent illness as a result of electrolyte abnormalities or inflammation. Some studies looking at ECG abnormalities like the one you describe, have shown that there is some increased risk when compared to those with a normal ECG. However, many authors have concluded that the long term prognosis depends more on the associated diseases than the T-waves themselves.  I think that given your previous normal studies and your lack of symptoms you are likely at low risk. Checking some blood tests for electrolytes may be reasonable.

Thanks for your question,


CCF-MD-KE

[mdcath]

This may be a silly question but ... what is a healthy 29 year old with no history of heart problems doing getting an annual ECG in the first place??? This is not good medical practice. Such unnecessary tests lead to more unnecessary and expensive testing, exactly as in this case.

[dblaso]

I am 29 and remember getting ECGs during my physicals as early as 20 years old.  I think it's good practice.  Being young does not mean that you can't have any heart issues.  I am not necessarily talking about coronary artery disease, but other conditions such as arrhtyhmias, cardiomyopathy, etc.  If you had something going on, wouldn't you rather know sooner than later?

I also want to make the comment that I started getting heart related symptoms (palpitations) after suffering with a serious flu.  I have heard other people say the same thing so I wonder what the connection is.

[RTFLY]

Performing routine ECG's on annual physicals is not bad medical practice. A lot of athletes undergo these exact tests. Although all physicians do not perform these tests on everyone, it is certainly not out of the question. It sounds as if the physician was concerned and I can't see that as being bad.
                                              
                                     JCI, BS RRT

[kptocs]

A related discussion, Fibromuscular dysplasia and heart disease was started.