Anterior and Inferior T-Wave Inversion: A Diagnostic Challenge and the T₁T₂T₃/_III Pattern

Area of Science:

• Cardiology
• Diagnostic Electrocardiography

Background:

• Right ventricular (RV) involvement in pulmonary embolism (PE) can be challenging to diagnose.
• Electrocardiogram (ECG) findings suggestive of acute coronary syndrome (ACS) may sometimes mask RV strain.

Purpose of the Study:

• To introduce and describe a novel ECG pattern, the T₁T₂T₃/_III pattern.
• To highlight the utility of this pattern in identifying RV involvement in PE.

Main Methods:

• A case presentation of a 73-year-old man with dyspnea and chest pain.
• Analysis of ECG findings, specifically T-wave inversions in anterior and inferior leads (V1-V3 and III).
• Comparison of the observed ECG pattern with the classic S_IQ_IIIT_III pattern.

Main Results:

• The patient presented with symptoms suggestive of ACS but ECG findings indicated RV involvement.
• The T₁T₂T₃/_III pattern was identified, characterized by specific T-wave inversions.
• This pattern was proposed as a mnemonic for RV strain.

Conclusions:

• The T₁T₂T₃/_III pattern is a useful descriptor for repolarization abnormalities indicative of RV involvement.
• Early recognition of this ECG pattern can facilitate the diagnosis of PE with RV strain.
• Distinguishing PE with RV involvement from ACS is crucial for appropriate management.