Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature

Table 1 Demographic features, clinical presentations, diagnostic modalities and management

Case/gender/age	Clinical presentation	ECG (SR)T-wave inversion	QTc (msec)	Associated disorders	TTE	Diagnostic modalities	Management	Condition
1- F51	Palpitation	15 mm in V2-6	452	AVNRT Depression	Apical hypokinesia	TTE CAG MRI	MM	Post-ECT. TTC (electrical stress)
2-F82	Chest pain	10 mm in V1-4	484	Mild AS PG 18 mmHg	Apicoinferior hypokinesia LVH	TTE	MM	NSTEMI
3-F72	Abnormal rest ECG	5 mm in V2-6	553	PAF 2011 Temporal arteritis Carotid endarterectomy Cluster headache	LVH	TTE CAG PV scan MRI	MM	TTC (emotional stress, spouse died 2 wk earlier)
4-F69	Inter-scapular pain	9 mm in V2-5	520	TIA 2010	Normal	TTE CAG PV scan MRI CT brain	MM	Undetermined
5-M55	Chest pain	1 mm in V1-3 S1 Q3 T3	432	-	Dilated hypokinetic RV ePAP 75-80 mmHg	TTE CAG PCTA	MM	Pulmonary embolism
6-F52	Fatigue	5 mm in V3-6	409	-	LVH	TTE CAG	MM	HCM
7-M76	Left abdominal pain and psychomotor agitation	20 mm in V2-6	639	IMI 1990 PCI RCA 1990 and 2004 PCI LAD 1991	Apical Hypokinesia LVH	TTE CAG CT thoracic aorta Ultrasound abdomen CT abdomen 123I-MIBG DOPA-PET Pathology	Surgical left adrennalectomy MM	TTC. Pheochromocytoma (hormonal stress)
8-M73	VF, OHCA	Epsilon V2 4 mm in V1-5	424	Negative family history	RV dilatation	TTE CAG Genetic counseling	MM, AAD Refused ICD implantation Advise to refrain from strenuous exercise	ARVC/D

AAD: Antiarrhythmic drug; ARVC/D: Arrhythmogenic right ventricular cardiomyopathy/dysplasia; AS: Aortic valvular stenosis; AVNRT: Atrioventricular nodal reentry tachycardia; BB: Beta blocker; CAD: Coronary artery disease; CAG: Coronary angiography; ECT: Electroconvulsive therapy; MM: Medical management; CRB: Calcium reentry blocker; CT: Computed tomography; ePAP: Estimated pulmonary artery pressure; F: Female; HCM: Hypertrophic cardiomyopathy; IMI: Inferior myocardial infarction; LAD: Left anterior descending coronary artery; LVH: Left ventricular hypertrophy; M: Male; MRI: Magnetic resonance imaging; NSTEMI: Non ST elevation myocardial infarction; OHCA: Out of hospital cardiac arrest; PAF: Persistent atrial fibrillation; PCI: Percutaneous coronary intervention; PCTA: Pulmonary computed tomography angiography; PET-CT: Positron emission tomography-computed tomography; PG: Peak gradient; PV scan: Perfusion-ventilation scan; RCA: Right coronary artery; RV: Right ventricle; SR: Sinus rhythm; TIA: Transient ischemic attack; TTC: Takotsubo cardiomyopathy; TTE: Transthoracic echocardiography; VF: Ventricular fibrillation; ECG: Electrocardiographic.