Hello, Thank you for your question. The types of T wave abnormalities are varied and include subtle straightening of the ST segment, actual ST segment depression or elevation, flattening of the T wave, biphasic T waves, or T wave inversion. In the absence of a clinical history or symptoms, T wave abnormalities and flattened and depressed ST segment changes are nonspecific. Causes of these changes include: functional and physiologic variants, electrolyte abnormalities, post cardiac surgical state, anemia, fever, acidosis or alkalosis, endogenous catecholamines, drugs, such digoxin, acute abdominal process, endocrine abnormalities, pH changes, cerebrovascular accidents, disease such as myocarditis, cardiomyopathy, pulmonary emboli, infections, amylodosis, systemic diseases, lung disease, myocardial ischemia. ect. For another cause of right precordial T wave inversion is the persistent juvenile T wave pattern. The wave vector maybe directed posteriorly in children, resulting in an inverted T wave in the right precordial leads V1 to V3. The vector usually becomes anterior with age, resulting in upright T waves in these leads, However, the T waves may remain inverted in V1 to V3 in a minority of adults, a finding known as a persistent juvenile pattern. So if you have symptom and risk factor for myocardia ischemic please go to see your doctor. Hope I have answered your question. Let me know I can assist you further. Best regards, Dr. Heang Chan Raksmey, General and Family Physician.