The pathogenesis of reversible T-wave inversions or large upright peaked T-waves: Sympathetic T-waves

•Reversible T-wave inversions (TWI) and large upright peaked T-waves (LUPTW) are reviewed.•TWIs and LUPTWs before and during the takotsubo syndrome (TS) era are discussed.•The pathogenesis of both TS and reversible TWIs and LUPTWs is reviewed.•A proposed pathogenetic term “sympathetic TWIs or LUPTWs” is presented.

Reversible electrocardiographic (ECG) repolarization changes including T-wave inversions (TWI), large upright peaked T-waves (LUPTW) and prolongation of the corrected QT interval (P-QTc) have been reported in association with myriads of acute cardiac and non-cardiac diseases. Through the last 70 years, the TWIs have been described under different terms as; cerebral, giant, global, canyon, Wellens or coronary and cardiac memory T waves. During the last 15 years, the reversible TWI and LUPTW in association with P-QTc have been described as characteristic ECG features in takotsubo syndrome (TS), which also may be triggered by the same aforementioned acute cardiac and non-cardiac disease entities. The pathogenesis of these reversible T-wave changes is not clear-cut. In this manuscript, substantial evidences for a causal link between the local cardiac sympathetic disruption and the development of the reversible TWI and LUPTW are presented. As a result, a pathogenetic term for the reversible TWI or LUPTW, which is sympathetic T waves (sympathetic TWI or sympathetic LUPTW), would be the most appropriate term.