Left or Right? When Diffuse T-Wave Inversion Is Worse Than Coronary Ischemia

Chest pain associated with new diffuse T-wave inversion in the electrocardiogram (ECG) is an alarming presentation, but it is not always associated with coronary ischemia. A 41-year-old man with sickle cell disease was hospitalized for a one-day history of vomiting, diarrhea, and abdominal pain. He also described bilateral hip pain consistent with prior sickle cell crises. In addition, he reported non-exertional substernal chest pain that was not typical for his sickle cell disease. A 12-lead ECG demonstrated sinus rhythm with negative T-waves both in the inferior and in the anterolateral leads (Figure 1).