Inverted T waves due to coronary artery disease and previous myocardial infarction were observed to revert to normal, upright position during ischemia in 38 patients. The normalization of inverted T waves was seen on the electro-encephalograms of 19 patients during spontaneously occurring angina pectoris and of 11 patients when ischemia was provoked by treadmill exercise; for 8 patients, normalization occurred during the administration of isoproterenol hydrochloride and during the consequent episode of angina pectoris. The mechanism for normalization may be the algebraic sum of the extent of ST segment elevation and the amplitude of the T waves of acute ischemia plus the extent of preexisting ST segment depression and the degree of T wave inversion, to result in isoelectric ST segment and upright T wave. As with myocardial infarction, reciprocal changes may also be recorded. However, the reciprocal nature may be masked since either acute ST segment elevation or T wave inversion, or both, may not be recorded in the leads reflecting the ischemic area because of normalization.
(Arch Intern Med 136:391-395, 1976)