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ECG of the week #20: 60 year old with shortness of breath – why the T wave inversions?

Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.

Clinical Scenario

A 60 year-old presented with shortness of breath

ECG

Question

What’s causing the T wave inversions?

ECG Analysis

Heart rate/rhythm: normal sinus
Electrical conduction: long QT
Axis: normal
R-wave progression: normal
Tall/small voltages: normal
ST/T: diffuse deep TWI

Answer

Takotubo, rule out wraparound LAD reperfusion. Angio showed normal coronaries and apical ballooning

Clinical Pearl

Takotsubo (stress-induced cardiomyopathy) causes long QT with diffuse deep T wave inversion, but is an angiographic diagnosis of exclusion after ruling out wraparound LAD reperfusion.

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