Anatomic and prognostic significance of new T-wave inversion in unstable angina

Haines, David E.; Raabe, Daniel S.; Gundel, Walter D.; Wackers, Frans J. Th.

doi:10.1016/0002-9149(83)90061-9

Cited by 145 publications

(64 citation statements)

References 20 publications

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“…35 Patients with this ECG finding often exhibit hypokinesis of the anterior wall and are at high risk if given medical treatment alone. 36 Revascularization will often reverse both the T-wave inversion and wall-motion disorder. 37 Nonspecific ST-segment and T-wave changes, usually defined as ST-segment deviation less than 0.5 mm (0.05 mV) or T-wave inversion less than or equal to 2 mm (0.2 mV), are less diagnostically helpful than the foregoing findings.…”

Section: Electrocardiogrammentioning

confidence: 99%

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Feldman¹,

Hirshfeld²,

Kern³

et al. 2008

Circulation

704

157

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Section: Electrocardiogrammentioning

confidence: 99%

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Feldman¹,

Hirshfeld²,

Kern³

et al. 2008

Circulation

704

157

View full text Add to dashboard Cite

“…In the early phase of NSTE‐ACS, T‐wave abnormality and ST depression reflect changes in myocardial cellular electrophysiology related to temporary myocardial ischemia without permanent cell damage 33. Furthermore, T‐wave abnormality can occur in conditions other than acute myocardial ischemia, and each may have a different underlying pathophysiological mechanism 34…”

Section: Discussionmentioning

confidence: 99%

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

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BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

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“…2 Furthermore, hypokinesis of the anterior wall associated with this ECG pattern could identify a group of patients at high risk with medical treatment. 5 Myasthenia gravis is a rare disorder that is not usually considered in the differential diagnosis of either ST elevation myocardial infarction (STEMI) or unstable angina/non-STEMI 1,2 ; however, the disease may present with ECG changes and left ventricular wall motion abnormalities. The involvement of the heart in MG has been reviewed beginning in the 1970s, including the association E76 Clin.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Pseudoischemic Electrocardiogram in Myasthenia Gravis with Thymoma: Reversibility After Thymectomy

Chiavistelli

Cei

Carmignani

et al. 2009

Clinical Cardiology

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Abnormal ST T‐wave changes can be found at presentation in various noncoronary disorders; misinterpretation of these patterns as ischemic heart disease can lead to erroneous diagnosis and treatment. Here we present a case of myasthenia gravis (MG) with thymoma, in which the resting electrocardiogram (ECG) led to a misleading diagnosis of myocardial ischemia. After thymectomy, the ECG resumed a normal pattern. Myasthenia gravis is not usually considered in the differential diagnosis of conditions associated with an abnormal ECG. The combination of dysphagia, dyspnoea, ECG changes, and creatine kinase (CK) elevations may easily bring to mind an erroneous and possibly deleterious diagnosis of myocardial ischemia. Copyright © 2009 Wiley Periodicals, Inc.

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Anatomic and prognostic significance of new T-wave inversion in unstable angina

Cited by 145 publications

References 20 publications

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Pseudoischemic Electrocardiogram in Myasthenia Gravis with Thymoma: Reversibility After Thymectomy

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