Transient peaked T waves during exercise stress testing: an unusual manifestation of reversible cardiac ischemia

A 57-year-old man presented with atypical upper body pain, initially attributed to musculoskeletal etiology. After analgesic failure, an exercise myocardial perfusion imaging was performed. During stress testing, patient's pain was reproduced, accompanied by prominent T-wave peaking with minor J-point elevation. T-wave amplitude decreased at the end of the recovery phase when his chest pain completely resolved. The myocardial perfusion imaging revealed extensive reversible ischemia of the septum and apical walls. Subsequent coronary arteriography demonstrated a 99% stenosis of the left anterior descending artery that was stented. Patient has remained asymptomatic since. We conclude that transient peaked T waves with minor J-point elevation during exercise may be an unusual electrocardiographic manifestation of reversible cardiac ischemia.