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Patient
71-year-old woman, severe hypertensive, diabetic, hospitalized for chest pain; ECG recorded in absence of pain;
Trace
Sinus rhythm, normal PR-interval; negative, deep (> 5 mm in V2-V3), and symmetrical T-waves in V1, V2, V3 and biphasic in V4; left ventricular hypertrophy (positive Sokolow index); coronary angiography revealed a severe stenosis of the proximal LAD;
Exergue
The presence of negative, symmetrical and peaked T-waves corresponding to a given myocardial territory should evoke an ischemic origin depending on clinical context.
As explained previously, the normal T-wave in adults is positive in all leads except for aVR and V1. The appearance of negative T-waves is therefore abnormal and suspicious.