“Persistent Juvenile” T-Wave Pattern May Not Be Persistent: Case Series and Literature Review

BackgroundT-wave inversions (TWI) can signify serious pathology, but may also represent a benign variant. One such variant has been termed the “persistent juvenile” T-wave pattern (PJTWP). It is characterized by TWI in the right precordium, and has been understood to represent an arrested stage of the normal electrocardiographic evolution from childhood.Case ReportA series of four African-American (AA) women, ages 20 to 43 years, presented to the Emergency Department, and were found to have right precordial TWI that was absent on prior electrocardiograms. The diagnostic evaluation did not reveal acute cardiopulmonary causes for these new TWIs.Why Should An Emergency Physician Be Aware of This?The “persistent” juvenile pattern may not be actually persistent in the individual patient. In an appropriate patient, such as a young AA woman, where acute cardiopulmonary disease has been reasonably ruled out, the finding of new right precordial TWI should not preclude the diagnosis of PJTWP.