Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature

Figure 3 Patient 3. An electrocardiographic (ECG) tracing, illustrating the negative T-wave in the precordial leads V_2-6, of a 72-year-old-woman who underwent 6 mo earlier direct current electric cardioversion for persistent atrial fibrillation. Her concomitant medical history includes temporal arteritis, carotid endarterectomy and cluster headache. She presented with abnormal rest ECG during out-patient follow-up. Her spouse died 2 wk prior to presentation. The cardiac markers were minimally elevated. The diagnosis of Takotsubo cardiomyopathy was strongly suggested as the emotional stress may have been the trigger. Transthoracic echocardiography depicted biventricular normokinesia with hypertrophic LV. Pulmonary perfusion-ventilation scintigraphy, Coronary angiography and cardiac MRI were all normal. She did well on pharmacological treatment with oral vit K antagonist, class 3 antiarrhythmic drug, anti-depressive drug and diuretics. The ECG alterations returned to baseline over a 6 mo period.