Giant T wave inversion associated with severe aortic regurgitation

Two patients with haemodynamically significant aortic regurgitation and angiographically normal coronary arteries developed giant T wave inversion. The T wave abnormality partially resolved in both; following valve replacement in one and medical treatment in the other. This unusual electrocardiographic appearance may be related to myocardial ischaemia caused by increased left ventricular wall stress and changes in phasic coronary blood flow, abnormalities in cerebral perfusion associated with severe aortic regurgitation, or to coincidental neurological disease.