Isolated T wave Inversion in Lead aVL as an early sign of Inferior Wall Myocardial Infarction

Abstract

Electrocardiogram (ECG) is instrumental in identifying acute myocardial infarction (AMI). ST-segment elevation in a region of specific  coronary vessels in an acute coronary syndrome (ACS) setting is the hallmark of AMI. Reciprocal ST depression and T wave inversion  (TWI) are well-recognized changes that could accompany ST segment elevations. Reciprocal changes may represent the only early  manifestation of AMI and may be present in specific leads such as lead aVL as early and sensitive markers of AMI. Abnormalities in the ST  segment and T wave can result from non-ACS causes, but early recognition and appropriate intervention are paramount for patients with  ACS. We report a case of a 55-yearold male with acute IWMI with early reciprocal and dynamic ECG changes with a literature review. This  case report highlights subtle ECG changes in lead aVL that require attention when evaluating patients with ACS. Serial ECG in a short        interval is essential when noticing this specific change.