Inverted T wave

A downward-pointing negative wave on an ECG, reflecting altered ventricular repolarization that may be physiological or associated with ischemia, structural heart disease, metabolic disturbances, medications, or secondary conduction abnormalities.

Causes

• Ischemic and coronary causes

  • Myocardial ischemia

  • Myocardial infarction

  • Wellens syndrome

  • Coronary artery disease

• Structural cardiac causes

  • Ventricular hypertrophy

  • Hypertrophic cardiomyopathy

  • Takotsubo cardiomyopathy

  • Other cardiomyopathies

• Pulmonary and vascular causes

  • Pulmonary embolism

  • Right ventricular strain conditions

• Neurological causes

  • Traumatic brain injury

  • Stroke

  • Intracranial hemorrhage

  • Increased intracranial pressure affecting cardiac repolarization

• Hypokalemia

• Medication-related causes

  • Digoxin

  • Antidepressants

• Normal variants

  • Physiological T-wave inversion in leads V1–V3, particularly in some healthy individuals

  • Age-related or positional ECG variations