When ‘Normal-Looking’ T Waves Hide a Worsening Heart Attack

A 70-year-old man with dynamic T-wave alterations and subthreshold ST-segment changes initially showed a 95% mid-left anterior descending artery stenosis with Thrombolysis in Myocardial Infarction (TIMI) 2 flow on angiography, according to a case report published in BMC Cardiovascular Disorders. Immediate percutaneous coronary intervention was recommended, but the patient declined after his symptoms eased, despite risk counseling.

During recurrent chest pain, transient T-wave pseudonormalization and subtle negative post-T-wave deflections were initially underrecognized. The report notes that temporary symptom relief and the failure to compare earlier electrocardiograms contributed to continued observation rather than urgent reintervention. Previously inverted T waves becoming upright during recurrent symptoms can appear deceptively reassuring on an isolated tracing.

Medically refractory symptoms and serial ECG changes eventually prompted repeat angiography, which confirmed progression to subtotal occlusion with TIMI 1 flow. Two overlapping stents restored TIMI 3 flow. At 1.5 months, the patient remained asymptomatic, with upright precordial T waves and normal cardiac function on echocardiography.

The authors emphasize that strict reliance on traditional ST-segment elevation myocardial infarction criteria can miss acute coronary occlusion, and that serial comparison is particularly important when previously inverted T waves become upright during recurrent symptoms. Their conclusion is that dynamic repolarization abnormalities should be interpreted alongside symptoms and known coronary anatomy, and that an apparently improved isolated ECG should not delay urgent reassessment of recurrent ischemia.

Subject of Research: A case report of transient T-wave pseudonormalization and U-wave inversion during recurrent left anterior descending coronary ischemia.

Article Title: Transient T-wave pseudonormalization and U-wave inversion during recurrent left anterior descending coronary ischemia: a case report

Article References: Zheng, X.-B. (2026). Transient T-wave pseudonormalization and U-wave inversion during recurrent left anterior descending coronary ischemia: a case report. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-06911-5

Image Credits: AI Generated

DOI: 10.1186/s12872-026-06911-5

Keywords: ECG, T-wave pseudonormalization, U-wave inversion, coronary ischemia, left anterior descending artery, acute coronary occlusion, case report, angiography, percutaneous coronary intervention, ST-segment, BMC Cardiovascular Disorders, cardiology