Proximal RCA occlusion producing anterior ST segment elevation, Q waves, and T wave inversion

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

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Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽

10.1161/circ.118.suppl_18.s_947-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Anastasios Athanasiadis ◽

Birke Schneider ◽

Johannes Schwab ◽

Uta Gottwald ◽

Ellen Hoffmann ◽

...

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Wall Motion ◽

Apical Ballooning ◽

Left Ventricular ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

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ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0320 ◽

2018 ◽

pp. 1298-1301

Author(s):

Federico Migliore ◽

Sebastiano Gili ◽

Domenico Corrado

Keyword(s):

Left Ventricular ◽

Stunned Myocardium ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

Qt Interval Prolongation ◽

St Segment ◽

Reversible Left Ventricular Dysfunction ◽

Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

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Plausible mechanisms of the rapid conversion of ST-segment elevation to T-wave inversion in Takotsubo syndrome

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.08.031 ◽

2013 ◽

Vol 168 (5) ◽

pp. 4593-4595 ◽

Cited By ~ 7

Author(s):

John E. Madias

Keyword(s):

Takotsubo Syndrome ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Rapid Conversion

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Abnormal Q Wave, ST-Segment Elevation, T-Wave Inversion, and Widespread Focal Myocytolysis Associated With Subarachnoid Hemorrhage

Japanese Circulation Journal ◽

10.1253/jcj.60.254 ◽

1996 ◽

Vol 60 (4) ◽

pp. 254-257 ◽

Cited By ~ 24

Author(s):

Hironosuke Sakamoto ◽

Hiroshi Nishimura ◽

Kouji lmataka ◽

Keiko leki ◽

Toshinobu Horie ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Q Wave

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A STUDY OF ELECTROCARDIOGRAPHIC FINDINGS IN PATIENTS WITH ACUTE CVA

10.36106/gjra/1702782 ◽

2020 ◽

pp. 11-13

Author(s):

Prasad Ugaragol ◽

Edwin Jose

Keyword(s):

Cerebral Infarction ◽

Cerebral Hemorrhage ◽

P Wave ◽

Electrolyte Imbalance ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Electrocardiographic Findings ◽

Ecg Abnormalities

Background - Electrocardiographic abnormalities are common in patients with acute CVA, the possible mechanism of which is the disturbances in autonomic regulation and excessive stimulation of sympathetic nervous system resulting in disordered repolarization process. Physicians are often confronted due to ECG abnormalities in acute CVA since it often mimick that of myocardial ischemia. The present study was undertaken with the objective to describe the frequency and pattern of common ECG abnormalities in CVA. Methodology - This is a retrospective case series study conducted among patients with acute stroke admitted to HSK hospital bagalkot during February 2020 - August 2020. A 12 lead ECG of cases fulfilling the inclusion and exclusion criteria of our study were evaluated for characters like P wave,PR segment, QRS,ST segment, Q wave etc. Sample size estimation was done using open epi Software version 2.3.1 Results - Among the 90 cases, 70% had abnormal ECG. Among cerebral infarction 61(67.7%) cases, ST segment depression was found in 21(34.4%), Qtc prolongation in 16(26.2%), T wave inversion in 13(21.3%) and wide QRS in 14(22.9%). Among cerebral hemorrhage 24(26.6%), prolonged QTc was found in 10(41.6%), T wave inversion in 9(37.5%), ST segment elevation in 6(25%) and tall T wave in 4(16.6%) patients. In SAH patients, ST segment elevation was found in 2(40%), tall T wave in 2(40%), and T wave inversion in 2(40%). Conclusion - Abnormal electrocardiographic findings are common in patients with acute cerebrovascular accidents even in the absence of electrolyte imbalance or known organic heart disease. ECG abnormalities like ST segment elevation, tall T wave, T wave inversion, and prolonged QTc were commoner in cerebral infarction than in cerebral hemorrahge whereas ST segment depression was predominantly found in patients with cerebral hemorrhage. Understanding that these abnormalities are associated with acute CVA is important to avoid erroneous judgment of assigning these patients as having cardiac dysfunction.

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Abstract 15688: Electrocardiographic Patterns Differentiating "Apical Ballooning" From Anterior Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.15688 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Birke Schneider ◽

Kay Peters ◽

Udo Desch ◽

Jürgen Stein

Keyword(s):

Myocardial Infarction ◽

Adverse Events ◽

Apical Ballooning ◽

Qtc Interval ◽

Anterior Myocardial Infarction ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment

Introduction: Left ventricular apical ballooning (AB) mimics anterior myocardial infarction (AMI). This study assessed if the ECG can differentiate between these two syndromes with a similar clinical presentation. Methods: Among 2086 patients (pts) with an ACS, 33 (1.6%) with AB were identified (29 f, 4 m, median age 77 years) and compared to 28 consecutive age and sex matched AMI pts undergoing PCI of the LAD with similar findings on LV angiography. Results: AB pts arrived at the hospital later after symptom onset (median 21 vs 5 hours; p<0.001). On the admission ECG, the number of leads with ST-segment elevation (4 [3-6] vs 5 [5-7], p=0.005) and the magnitude of ST-segment elevation (0.7 [0.5-0.9] vs 0.9 [0.7-1.5] mV, p=0.002) were greater in AMI. Reciprocal ST-segment depression was similar (27% vs 54%, p=ns). A positive T wave in aVR was more frequent in AB (49% vs 7%, p<0.001). During follow-up, AB pts had more leads with T-wave inversion (8 [8-9] vs 6 [5-8], p<0.001) and a larger magnitude of T-wave inversion (2.9 [2.2-4.6] vs 1.4 [0.9-2.3] mV, p<0.001). T-wave inversion was similar in I, aVL and V2-V5. AB pts, however, showed negative T-waves also in lead II (74% vs 22%, p<0.001), III (34% vs 4%, p=0.004), aVF (51% vs 11%, p=0.001) and a positive T wave in aVR (100% vs 70%, p=0.005). The QTc interval was longer in AB (515 [482-543] vs 458 [435-484] ms, p<0.001). An abnormal Q wave on admission was more frequent in AMI (21% vs 79%, p<0.001) and persisted but was absent in AB at discharge (0% vs 61%, p<0.001). Ventricular tachycardia was similar (2% vs 14%, p=ns) but atrial fibrillation occurred only in AB (21% vs 0%, p=0.013). The ECG normalized in all AB but in only 1 AMI pt (p<0.001). Overall, despite a similar ejection fraction (54±15 vs 55±13 %) and lower troponin I values (7.5±6.9 vs 238±221 ng/ml, p<0.001), AB pts developed significantly more adverse events compared to AMI pts (52% vs 18%, p<0.008). Conclusion: ECG patterns in AB are significantly different from those in AMI. On admission, the extent of ST-segment elevation and the number of Q waves are greater in AMI. During follow-up, no Q wave, a longer QTc interval, a greater extent of T-wave inversion and a positive T wave in aVR are typical findings in AB. Adverse events are more frequent in AB than in AMI.

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Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s14086 ◽

2014 ◽

Vol 8 ◽

pp. CMC.S14086 ◽

Cited By ~ 18

Author(s):

June Namgung

Keyword(s):

Acute Coronary Syndrome ◽

Takotsubo Cardiomyopathy ◽

Apical Ballooning ◽

Left Ventricular ◽

Qtc Interval ◽

St Segment Elevation ◽

Coronary Syndrome ◽

T Wave ◽

Wave Inversion ◽

St Segment

Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

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