• Laszlo Littmann.
• Department of Internal Medicine, Atrium Health Carolinas Medical Center, Charlotte, NC, United States. Electronic address: Laszlo.Littmann@gmail.com.
• Am J Emerg Med. 2024 Aug 1; 82: 215.e3215.e5215.e3-215.e5.

AbstractIn the acute care setting, the two most common causes of giant upright T waves include hyperkalemia and the very early phase of acute myocardial infarction (MI). The former is characterized by narrow based and peaked T waves. The giant T waves of early MI, also called "hyperacute T waves," are usually more broad-based. The general recommendation is to consider hyperacute T waves a form of occlusion MI, and to proceed with emergent cardiac catheterization and revascularization. In this report, we present the case of a young man with cocaine toxicity and status epilepticus where the initial electrocardiogram (ECG) demonstrated giant T waves. Both hyperkalemia and coronary occlusion were ruled out. Within a few hours, the ECG spontaneously normalized. Review of the literature revealed that although uncommon, acute cerebral events including seizures can cause transient giant T waves. When giant T waves are noted in association with a cerebral event, emergent cardiac catheterization may not be warranted.Copyright © 2024 Elsevier Inc. All rights reserved.

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