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t-wave inversion
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t-wave inversion

42 year old male, physically fit with family history of heart disease. After 4 days of chest pains I went to the doctor. An EKG showed a change (from my previous EKG from 7 years ago) (t-wave inversion) which landed me in the ER. 3 troponin tests in the next 9-10 hrs all came back negative. The rest of my blood work was normal except a slightly low level of potassium (3.3) for which I was given some tablets. Chest x-rays were normal. BP and cholesterol levels normal. Adrenal function normal. I stayed overnight and the next morning they performed a nuclear stress test. My target rate was 151 but i was able to go beyond and reach 171 without any discomfort (other than being tired). The test came back normal. I was released from the hospital and I am scheduled to do an echo in about 10 days. I still have a little pain in my chest underneath the sternum that occasionally shoots out towardsthe left pectoral area in addition to more isolated sharper pain between the shoulders in the back. Even though the tests are all good so far I am worried about the t-wave inversion especially since earlier EKGs did not have that. What could cause the t-wave inversion and are there any other tests I should consider? What other questions should I be asking the cardiologist?
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367994_tn?1304957193
When viewing an EKG, other wave forms are evalutated as well for an assessment of the test outcome all of the waves are evaluated, not just one in particular. And apparently, the rest of the waves on the EKG appeared normal to rule out any sort of defect,  

For some insight, the T wave on an EKG represents resetting of the electrical heart cells in the bottom chambers of the heart and will be discharged causing contractions.

Your doctor will also rule out inverted T waves causes such as partially blocked or blocked vessls, heart attack, and list of other possible causes are "anxiety, certain medications, infections around the heart, pulmonary embolus (blood clot in the lung), electrolyte disturbance (abnormalities in sodium, potassium levels) etc."

Test to rule out ischemia (blocked vessels) is a perfusion stress test.  A contrast medium is injected into the blood stream and the vessel with any blockage would clearly be visable with exertion on a monitor.  If there has been a heart attack, dead tissue would be recognized.  Also, an echocardiogram can determine if there has been a prior heart attack as well as infection around the heart (pericarditis).  Pulmonary embolus can be detected with a cath to measure pressure of the pulmonary artery.  Blood tests for electrolyte imbalance.

Whether other tests are of interest for a possible dx would be based on your symptoms, etc. and a doctor's concern there may be a medical problem.

Hope this helps, and if you have any further questions you are welcome to respond.  Thanks for the question, take care.
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Avatar_m_tn
Thank you so much for the reply.
I am assuming that the perfusion stress test is the same as the nuclear stress test I was administered? That test came back normal. There were no other abnormalities in the EKG. The echo test is scheduled for this Friday. What worries me at this point is the fact that I still have some pain under the sternum - of course it could also be stress and anxiety from this whole situation.
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367994_tn?1304957193
Yes, you have had the appropriate test.  Your chest pain can be due to tenderness or sensitivity of the cartilage that joins the rib cage to the sternum. Keep us informed, take care.
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Avatar_m_tn
So my echo came up normal also. At this point the cardiologists says that we are done with any cardiac tests. I am still concerned by the unknown cause of the t-wave inversion. My chest pain lasted for 3 weeks and now has significantly subsided. I am thinking about at least checking with another cardiologist for peace of mind. Any suggestions/leads to follow for these symptoms are welcomed. Take care.
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