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What causes flattened T-wave in electrocardiogram (ECG)?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

Should the flattened T-wave in V2 - V4 be of concern? I have the following complaints: chest pain, left jaw pain, sternal tightness, and pressure in the left chest radiating to the left arm and shoulder. Currently, I am taking Metoprolol Tartrate 25 mg and Omeprazole 10 mg. I have undergone the laboratory tests for the following. I have done a complete blood count, a comprehensive metabolic panel, a partial thromboplastin time, a prothrombin time, and a thyroid-stimulating hormone. The result values of all the above tests are normal. Thank you.

Answered by Dr. Isaac Gana

Hello,

Welcome to icliniq.com.

Thanks for reaching out to us. Sorry about your health challenges. Please stay strong, and you will be fine. Generally, in an ECG (electrocardiogram), a flattened T wave in leads V2- V4 could be due to myocardial ischemia. Meaning there is a narrowing in one of the heart vessels leading to low perfusion. But this usually presents with abnormal blood work. Based on my clinical experience, it will be required for you to do a stress ECG or a coronary angiography. This will give us a more definite answer to the cause of your chest pain. It is difficult to rule out the possibility of coronary heart disease, as it will be evident on your BMI (body mass index) and cholesterol levels. Best regards.

Patient's Query

Hello doctor,

Thank you for the reply. I had a nuclear PET (positron emission tomography) stress test one and a half months ago, and the report was normal. I have a calcium channel score of 0. The treadmill stress test taken three months back was also normal. I took an echocardiogram six months ago and underwent CTA (computed tomography angiography) a month ago, both of which were also normal. I have attached my tracing, taken at home. Could it simply be lead placement or the way I was positioned?

Answered by Dr. Isaac Gana

Hello,

Welcome back to icliniq.com.

It might not be the issue of placement or positioning. There are many other causes of flat T waves in V2 - V4, like anxiety and hypokalemia (low potassium level in the blood). If the T waves on the ECG were pathological, there is a higher chance that one of the tests you did recently would be abnormal. When exactly did this current pain begin? Are you currently using any Statins or Aspirin?

Answered byDr. Isaac Gana

Medically reviewed byDr. K. Shobana

Published At May 13, 2022
Reviewed AtOctober 15, 2025

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