Benign Late T Wave Inversion Post CABG: Case Report of Myocardial Reperfusion Sign Appearing Late on ECG

Background: T wave inversion (TWI) has been described in a variety of clinical conditions, usually resolving in a timely manner after the index event. TWI has also been considered a robust sign of myocardial reperfusion appearing early after successful revascularization via fibrinolysis or percutaneous coronary intervention in ST-segment elevation myocardial infarction (STEMI) patients.

AIM: To report the late appearance of TWI after revascularization in a patient post-coronary artery bypass grafting (CABG), as a sign of successful myocardial perfusion.

Methods: A case report of a male patient presenting to King Abdulaziz hospital in the eastern region of Saudi Arabia with Non-ST-segment elevation myocardial infarction(NSTEMI) found to have triple vessel coronary artery disease, referred for CABG at King Abdulaziz medical city Riyadh Saudi Arabia with normal perioperative Electrocardiogram (ECG) and Echocardiogram, to revisit two months later with atypical chest pain and new non-ischemic persistent anterior TWI documented later on clinic visits.

Result and Conclusion: Extensive workup for a possible cause of new anterior TWI was conducted, therefore we concluded the new onset of anterior TWI late post CABG, was a benign sign of myocardial reperfusion.