A Mysterious Case of Acute T Wave Inversion at Anesthesia Induction: A Case Report

Detection and management of suspected intraoperative myocardial ischemia are critical for patient outcome. Following induction of general anesthesia, sudden global T-wave inversion appeared on continuous electrocardiogram (ECG) monitoring, raising suspicion for acute myocardial ischemia and prompting cancellation of surgery. The patient underwent a thorough evaluation for myocardial ischemia despite negative circulating troponin, but all tests were negative. The T-wave inversion persisted for 2 months. This case highlights the need for caution in interpreting isolated perioperative ECG changes in the era of heightened awareness for perioperative myocardial ischemia and routine troponin screening, to avoid unnecessary and potentially invasive investigations.