Education  |   August 2019
Giant T-wave Inversions in Apical Hypertrophic Cardiomyopathy
Author Notes
  • From the Departments of General Anesthesiology (S.K., R.S., K.M., K.R.), Outcomes Research (S.K., K.M., K.R.), and Critical Care Medicine (R.S.), Cleveland Clinic Foundation, Cleveland, Ohio.
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Khanna: khannas@ccf.org
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   August 2019
Giant T-wave Inversions in Apical Hypertrophic Cardiomyopathy
Anesthesiology 8 2019, Vol.131, 398-399. doi:10.1097/ALN.0000000000002732
Anesthesiology 8 2019, Vol.131, 398-399. doi:10.1097/ALN.0000000000002732
Giant T-wave inversion is defined as T-wave inversion that is greater than 10 mm in any electrocardiography lead, whereas global T-wave inversion refers to inverted T waves in all standard leads except augmented voltage right arm (aVR). The accompanying image exhibits these uncommon electrocardiography findings. Anesthesiologists often have to decide whether additional investigations are required in patients who exhibit T-wave inversions in the perioperative period. Nonspecific T-wave inversions occur commonly in surgical patients and are clinically benign.1  In contrast, giant negative T waves occur in specific conditions such as left main or equivalent myocardial ischemia and apical hypertrophic cardiomyopathy.2  Regardless of the degree of T-wave inversion, concomitant presence of chest pain, dyspnea, and ST-segment changes should prompt further cardiac work-up and consultation.1