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Abstract
The most striking ecg abnormality in patients with aortic stenosis is inversion of the T-wave in left ventricular leads and is almost invariably present when the voltage in these leads is high. Although the voltage changes in patients with coarctation of the aorta and hypertension without associated ischemic heart disease are comparable, T wave inversion is of greater magnitude and more frequent in aortic stenosis and the depth of inversion correlates with the degree of severity of the stenosis and the duration of the maximal ejection phase of ventricular systole. On the basis of clinical data as well as necropsy findings, the author suggests that the T wave inversion is ischemic in origin and due to poor coronary flow rather than to coronary artery disease. Atrial fibrillation and bundle branch block were late manifestations but first degree heart block occurred early in the disease.