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What Does It Mean When "T Wave Immersion Is Now Evident In Anterior Leads" In An EKG Report?

Posted on Mon, 13 Nov 2023

Question: I need to get clearance for surgery. The ekg reviewed by cardiology said when compared to previous ekg.."t wave inversion now evident in anterior leads" what does that mean and is it anything significant?

Answered by Dr. Sagar Makode (52 minutes later)

Brief Answer:
Suggests the possibility of coronary artery disease

Detailed Answer:
Hello,
There is T wave Inversion in leads V1-4, which suggests the anterior portion of heart is getting less blood supply, and this deficiency of blood supply is seen as T wave Inversion on ecg. Ecg is not confirmative and you ll have to get additional test done like Echo, either stress thallium or CT coronary angiography if echo is normal. If echo is abnormal then you ll need directly angiography.
You are unlikely to get clearance unless you get higher test which I mentioned above.
Hope this helps you and get back if you have any doubts.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Sagar Makode (39 minutes later)

I was told in the past that I had an incomplete RBBB. Could that be the cause of those t wave inversions? And is it ever normal to have inverted t waves in all those leads? I have intermittent episodes of feeling pressure on my chest or shortness of breath and sometimes would have discomfort in my arms. But it happens randomly, not always with exertion. I had a stress echo last year and it was normal.

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
Can occur sometimes normally

Detailed Answer:
These changes sometimes may occur normally, but we need to rule out ischemia. RBBB is not very striking and unlikely to be related to it.
Did you have same changes in ecg last year, while you had stress echo, if not then these new changes needs to investigated. Even if yes then additional test should be done to ascertain. All the best.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Sagar Makode (11 hours later)

I added another ekg I had last year just to see if you think they look similar. I've been having a lot of cardiac symptoms over the past year and they tell me I am young and don't need to worry about it. Lately it seems to be acting up again and I don't want to go back to the cardiologist because they said I seem fine but I don't want my surgery to get help up. I don't think my primary doctor or surgeon looked at my ekg yet because they are from different hospitals. So I wanted to see what you thought and if I should call them now and have them review or if I should wait until I see them 2 days before surgery. I don't want to have it postponed.

Answered by Dr. Sagar Makode (12 minutes later)

Brief Answer:
Ecg is better

Detailed Answer:
Hi,

Your previous ECG was better and has T wave Inversion only in v1-2 which is usually a normal variant. Currently, ECG is new changes. Considering you are young, the probability of blockages go down. So likely, these are false positive changes but needs to be confirmed.

You should call and ask them to review the ECG, because, anaesthesiologist unlikely to take up for surgery without cardiological clearance. So, it's better to take action now rather than delaying the surgery.

All the best.

Above answer was peer-reviewed by : Dr. Arnab Banerjee