Global T-wave inversion in a 77-year-old woman.

77-year-old woman came to the emergency department with dyspnea and T-wave inversions that became deeper and more diffuse over the next 15 hours (Figure). T waves were inverted, in most leads symmetrically, in all leads except aVR and V1, and the QT interval (604 ms with a QTc of 643 ms) was markedly prolonged. Walder and Spodick described this electrocardiographic pattern as global T-wave inversion, found it in 100 of 30,000 consecutive electrocardiograms, and noted that 82 of the patients were women (1). Others have used the term diffuse T-wave inversion for this widespread T-wave inversion which always shows a reciprocal upright T wave in lead aVR and may also spare leads V1, III, and/or aVL (2). When unusually deep inversion of the T waves is the most salient feature of global T-wave inversion, the condition is sometimes referred to as giant negative T waves. The most common cause of global T-wave inversion is myocardial ischemia. This patient’s troponin I peaked at 2.4 ng/mL (reference, <0.05). Her echocardiogram and angiographic left ventriculogram revealed severe hypokinesis to akinesis of the anterolateral wall and apex with an ejection fraction of 35%, and the chest radiograph showed florid pulmonary edema. Because she had no history of prior myocardial infarction and because the troponin I was only slightly elevated on the current admission, most of the left ventricular dysfunction was probably due to ischemic stunning. Coronary arteriography displayed the Electrocardiographic Report