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

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-year-old male with acute IWMI with early reciprocal and dynamic ECG changes with a literature review.