Giant T Wave Inversion After GA

Report:

Sinus rhythm

Left axis deviation

Giant T wave inversion

Comment:

Schamroth rightly states that syncope is the preceding event in cases of giant T wave inversion. In this case (and only two others, in my experience) the only syncope had been that induced by anæsthesia. Given the catecholamine surge as the putative mechanism, it is quite conceivable that GA would sometimes do this.

There was no evidence of perioperative infarction; the ECG eventually subsided into his pre-operative pattern of LAD with nondescript ST/T changes (191a).

Perioperative T wave changes are common and generally benign139. The ones seen here are, however, of a different order of magnitude. My other two patients' ECGs with massive T wave inversion following GA are shown on the next sheet (Figs 191b, 191c). The only factor possibly accounting for all three is the preceding uncomplicated general anæsthesia. The last example had it three times postoperatively, never showing any evidence of ischæmia or infarction.