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Heart & Cardiology/T-wave inversion reverts to normal during nuclear stress test


My 52 y.o. husband had been working on some projects using a hammer several weeks ago. When swinging the hammer, he felt a sharp pain under his left pec muscle, wrote it off thinking it was a pulled muscle.  After three weeks feeling the occasional sharp pain, fatigue and tightness in his chest he finally went to the Urgent Care who immediately did an EKG. The test revealed T-wave inversion and they suggested he go right to the ER. All EKG performed prior to this episode have been normal. At the ER, they performed another EKG, and had blood drawn to check for clots and heart attack. EKG (12 lead) still exhibited T-wave inversion, blood tests were normal.  ER did a 64 slice CT Scan, results nothing remarkable.  He then went for a stress test, 14 minutes rate up to 191, results excellent fitness, T-wave inversion, nothing remarkable.  He had an echocardiagram, has what the cardiologist refers to as a 2 1/2 cuspid aorta along with ST & slight regurgitation, but the results were the same as three years ago, as our daughter has a bicuspid aorta and we wanted to check the family. He has now gone for a nuclear stress test, and the PT mentioned his t-wave inversion reverted to normal during the exercise portion - he did have to run to get his heart up to the necessary rate.  At rest, his t-wave inversion was present again.  What, if anything, is this indicative of?

Hi Ginny,
There are a variety of causes for NEW T-wave inversions, but they are always abnormal, with the most common one to be excluded Coronary Artery Disease. Others would have been found with this very complete evaluation: all the tests came out normal. The bicuspid aorta is not an issue at this point, but may become a problem later in life. With that information I cannot explain these EKG findings other than to assume they may have been associated with his chest wall injury.
The only important conclusions: NO CAD, NO arrhythmia, no hypertensive changes to his heart.
Hope this helps,
Dr T

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