T-wave pseudonormalization is often seen in acute myocardial ischemia, but it can also occur in patients without significant coronary artery disease. A case of stress cardiomyopathy resulting in T-wave pseudonormalization was recently reported by Dr. Rassiwala from the University of California and published in full in JAMA Internal Medicine. T-wave pseudonormalization is thought to be associated with myocardial ischemia and was initially shown to occur in patients with baseline level T-wave inversions during spontaneous or trigger-induced angina attacks, with corresponding coronary stenosis of 75% or more in these patients. The cellular and electrophysiological mechanisms underlying the pseudonormalization are not fully understood; however, a common view is that T-wave pseudonormalization is caused by a new ischemic event in the setting of chronic ischemic injury, resulting in a shortening of the cardiomyocyte action potential time course. Although T-wave inversion and ST-segment elevation in the precordial leads are often indicative of anterior wall infarction, these two ECG changes are also two of the most common manifestations of stress cardiomyopathy. There are four stages in the ECG presentation of stress cardiopathy: (1) ST-segment elevation after the onset of symptoms; (2) decline of the elevated ST end and T-wave inversion within 1-3 days; (3) transient improvement of T-wave inversion; and (4) deep T-wave inversion lasting several months. No previous studies have reported pseudonormalization of T waves in patients with stress cardiomyopathy, and this case suggests that pseudonormalization of T waves can occur in patients without coronary artery disease. In 1991, Dote et al. reported that a state of psychological or physical stress could induce transient left ventricular insufficiency, with a specific myocardial motion incoordination on left ventricular angiography, in which the apical and inferior anterior wall motion of the left ventricle is reduced or absent, while the basal myocardial motion is compensated. The patient has a specific myocardial motion incoordination. It was named “Tako-tsudo” (octopus fistula) cardiomyopathy because of the image of a rounded base and narrow neck at the end of systole, which resembled an ancient Japanese basket for catching octopus. Later, French scholars reported 2 similar cases, pointing out that elevated catecholamine levels during stress and the disease were clearly associated, and the concept of stress heart disease was introduced. The onset of the disease is sudden, and the majority of patients present with severe chest pain similar to that of acute myocardial infarction. Stress cardiomyopathy is often preceded by significant psychological or physical stress in the minutes or hours before the onset of symptoms. It is often triggered by some sudden emotional excitement (e.g., sudden event, death of a loved one, violent argument, overexcitement, etc.) or by aggravation of a pre-existing condition such as a cerebrovascular accident or seizure. The most important feature of the disease is the severe impairment of left ventricular systolic function at the beginning of the attack, but cardiac function often recovers within a week. In general, stress heart disease has the following main characteristics: the majority of patients are middle-aged and elderly women; there is a strong state of psychological or physical stress before the onset of the disease; the symptoms and ECG performance are similar to acute myocardial infarction, but the majority of patients do not have significant fixed stenosis in the coronary arteries; in the acute phase, patients have low systolic function, but cardiac function often recovers within a short period of time. In summary: 1, many diseases can lead to T-wave inversion, and in the case of coronary artery disease, subendocardial ischemia, acute coronary syndrome and old myocardial infarction can cause T-wave inversion; 2, T-wave pseudonormalization is often a sign of acute myocardial ischemia, and a series of ECG examinations can help to detect this phenomenon, but T-wave pseudonormalization can also be seen in patients without coronary artery disease; 3, T-wave inversion in precordial leads and ST-segment elevation often indicate ST-wave inversion. and ST-segment elevation are often indicative of ST-segment elevation myocardial infarction, but they are also the two most common ECG manifestations of stress heart disease.