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Inverted T wave in EKG. Stress test or echo test to be done in this case?

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General & Family Physician
Practicing since : 2009
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inverted t wave. whichis better stress test or echo?I have no medical history.
I do aerobic exercise of an hour a day on stair stepper, tread mill, and elliptical machine. I do have bad sinuses right now.I have had a t-wave in V2-V4 for the past 4 EKG or 4 years.
Could it be benign as it possibly could?
Posted Tue, 29 Oct 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Both would be required; ECHO first

Detailed Answer:
Hello sir and welcome.

Thank you for writing in.

A 'T' wave inversion is considered normal or harmless when seen specifically in lead III (3) of the EKG. But when seen in other parts of an EKG, and for such a long duration of time (in your case), conditions like: ventricular hypertrophy or other signs of heart enlargement, a disorder of the central nervous system (eg. raised intra-cranial pressure), pulmonary embolism, bundle branch block, a circulatory disorder, or a syndrome in which stenosis (hardening) of the left coronary artery and chest pain is seen.

In my opinion, both an echo and a TMT (treadmill test/stress test) would be advisable. But if you had to choose between the two, then an ECHO would be advised primarily. But please do consider taking both investigations, to help accurately diagnose your condition.

I hope this information helps you. Please feel free to write back to me for any further clarifications.

Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Inverted T wave in EKG. Stress test or echo test to be done in this case? 14 hours later
Very good info Thx!

So a TMT is different from a Nuclear Stress? (And much less expensive?)
But if on a budget, you would recommend the echo over the TMT for prelim investigation? But eventually both.

I have been reading much about the possibility of a benign inverted T-wave when in V3-V6 and not V1-V2. My inverted T is in V4-V6.

COULD IT POSSIBLY BE BENIGN?
 
 
Answered by Dr. Shoaib Khan 2 hours later
Brief Answer:
TMT cheaper; ECHO first; could be benign

Detailed Answer:
Hello once again sir.

Yes sir, a TMT is much cheaper and quite accurate as well. Yes sir, whether on a budget or not, an ECHO would be the primary investigation, which can then light the way forward, and help give us information on whether a TMT is required or not.

But yes, I would eventually advise both. Yes sir, it could still be benign, but as mentioned to you, it is best to rule out all conditions before considering this to be benign and harmless. I hope you understand.

My best wishes are with you. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

God bless.
Above answer was peer-reviewed by
 
Follow-up: Inverted T wave in EKG. Stress test or echo test to be done in this case? 2 hours later
Just in the few hours I have spent on the web, I have learned much about Inverted T waves. But my FP Physician knows very little and not sure of your knowledge.

So besides plaque in the artery, O2 issue with the lungs like cancer, or a blood clot near the heart, what other negative prognosis could result?
 
 
Answered by Dr. Shoaib Khan 6 minutes later
Brief Answer:
Other possible conditions listed

Detailed Answer:
Hello sir.

The other possibilities that I also listed in my first response are:
-Left ventricular hypertrophy
-Heart enlargement
-A central nervous system (eg. raised intra-cranial pressure)
-A clot in the pulmonary vein (controlling the respiratory system; this can result in sudden respiratory complications)
-Bundle branch block (a cardiac condition)
-A circulatory problem (which can result in thickening of blood, formation of clots, etc.)
-Wellen's syndrome (a syndrome in which stenosis (hardening) of the left coronary artery and chest pain is seen)

These are most of the negative results that could be causing the inverted 'T' wave sir. Which is why I requested an elaborate evaluation. I hope this information helps you. Please write back to me for any further clarifications, I would be more than happy to provide more information or elaborate on the already provided information.

Best wishes.
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