Negative T waves are frequently observed during coronary ischemia.

      However, ischemia is not the only cause of negative T waves.

  When ischemia is over, T waves are usually expected to become positive again.

  Ischemic T wave changes are usually accompanied by ST segment shift.

ECG 1a. ST depression in leads C4, C5, C6 and symmetrical negative T waves are seen in chest leads of a patient with unstable
angina. This patient underwent coronary artery bypass surgery for significant stenosis of the LAD and Cx vessels.

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ECG 1b. T wave negativity and ST segment depression in chest leads disappeared after successful coronary artery bypass

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ECG 2.
Flattening of the ST segment and peaking of the T wave are the first signs of coronary ischemia. This patient
complained of severe effort angina. Coronary angiography showed 3 vessel disease (extensive coronary artery disease).

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