Introduction Electroconvulsive therapy (ECT) is a well-established treatment for psychiatric conditions. Although effective, ECT can lead to various cardiovascular effects, such as heart rate fluctuations, blood pressure changes, and electrocardiographic (ECG) abnormalities. One notable ECG abnormality is T wave inversion (TWI), which may signal myocardial ischemia.

Case Presentation We present a case of a 45 year old male with treatment-resistant schizophrenia who developed new generalized T-wave inversion on ECG prior to his third monthly ECT session, despite having a previously normal baseline ECG. He exhibited no symptoms of angina or heart failure. Serial troponin and NT-proBNP levels were normal, and echocardiography revealed normal result. His cardiovascular risk factors included hypertension, active smoking, and a strong family history of ischemic heart disease. An inpatient coronary angiogram was performed revealing normal epicardial coronaries. The lack of clinical, biochemical, and imaging evidence of cardiac pathology led to the diagnosis of ECT-induced generalized T-wave inversion. The patient and psychiatry team were reassured and he was able to continue further ECT sessions without any complications.

Discussion This case highlights the importance of comprehensive cardiac evaluation in patients with unexpected ECG changes during ECT and underscores the need for awareness of ECT-induced cardiac manifestations among clinicians. ECT induces generalized tonic-clonic seizures through brief electrical pulses, leading to autonomic nervous system activation and transient cardiovascular effects. T wave inversion, while sometimes indicative of serious cardiac conditions, can be benign in the context of ECT. Studies suggest that ECG changes, including T wave inversion, are not uncommon during ECT and generally resolve without intervention. However, new onset of acute coronary syndrome or cardiomyopathy has been reported following ECT, emphasizing the need for careful cardiovascular assessment and monitoring, especially in patients with risk factors.

Conclusion T wave inversion during ECT is relatively not uncommon and often transient. Rigorous cardiovascular evaluation and monitoring are essential for the safe administration of ECT, particularly in patients with significant cardiovascular risk factors.