The natural history of the inverted T wave is variable, ranging from a normal life without pathologic issues to sudden death related to cardiac or respiratory syndromes.
A variety of clinical syndromes can cause T-wave inversions, from life-threatening events, such as acute coronary ischemia, pulmonary embolism, and CNS injury, to entirely benign conditions, such as normal variant T-wave inversions and the persistent juvenile T-wave inversion.
The normal T wave has been described to have a gradual upstroke with a more rapid downstroke in the terminal portion. This relative asymmetry may vary because many women and older patients without identifiable cardiac disease may have symmetric T waves.
Interpretation of the ECG in the context of the individual patient presentation allows the clinician to discern among normal, potentially abnormal, and abnormal.
The causes of T-wave inversions have been grouped into 2 categories: primary T-wave changes (alterations in the duration or morphology of the action potential, without concurrent changes in the orderly sequence of activation) and secondary T-wave changes (changes result from aberrant ventricular activation in the context of normal action potential characteristics).
All cases and images provided by William Brady, MD