title: Negative T wave in ischemic heart disease: a consensus article.
abstract: BACKGROUND
  For many years was considered that negative T wave in ischemic heart disease represents ischemia and for many authors located in subepicardial area.
  
  
  METHODS
  We performed a review based in the literature and in the experience of the authors commenting the real significance of the presence of negative T wave in patients with ischemic heart disease.
  
  
  RESULTS
  The negative T wave may be of primary or secondary type. Negative T wave observed in ischemic heart disease are of primary origin, therefore not a consequence of abnormal repolarization pattern. The negative T wave of ischemic origin presents the following characteristics: (1) are symmetrical and of variable deepness; (2) present mirror patterns; (3) starts in the second part of repolarization; and (4) may be accompanied by positive or negative U wave. The negative T wave of ischemic origin may be seen in the following clinical settings: (1) postmyocardial infarction due to a window effect of necrotic zone and (2) as a consequence of reperfusion in case of aborted MI when the artery has opened spontaneously, or after fibrinolysis, PCI, or coronary spasm.
  
  
  CONCLUSIONS
  Acute ongoing ischemia do not cause negative T wave. This pattern appears when the ongoing ischemia is vanishing or in the chronic phase. In all these cases the cause of negative T wave is not located in the subepicardial area. Furthermore, positive exercise testing is expressed by ST depression never by isolated negative T wave. There are many circumstances that may present negative T wave outside ischemic heart disease and that have been discussed in this paper.
authors.affiliation: Santa Creu i Sant Pau Hospital, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain.
authors.forename: Antonio Bayés
authors.initials: AB
authors.lastname: de Luna
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: Rafael
authors.initials: R
authors.lastname: Baranowski
authors.forename: Diego
authors.initials: D
authors.lastname: Goldwasser
authors.forename: Paul
authors.initials: P
authors.lastname: Kligfield
authors.forename: Ryszard
authors.initials: R
authors.lastname: Piotrowicz
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Hein
authors.initials: H
authors.lastname: Wellens
mesh_terms: D000818:Animals; D003326:Coronary Circulation; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology*
keywords: electrocardiography; ischemic heart disease; negative T wave