Certain Clinical States and Pathologic Changes Associated with Deeply Inverted T Waves in the Precordial Electrocardiogram

Pruitt, Raymond D.; Klakeg, Clayton H.; Chapin, Lemuel E.

doi:10.1161/01.cir.11.4.517

Cited by 69 publications

(14 citation statements)

References 5 publications

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“…The adult patients were from both the ward and private niedical and surgical services during a period of approximately 4 months. Although usually the records were taken for specific clinical indications, some represented routine preoperative electrocardiograins in the elderly age group.…”

Section: Methodsmentioning

confidence: 99%

"Nonspecific" ST and T-Wave Changes

Friedberg

Zager

1961

Circulation

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ONE of the commonest problems in electrocardiography is the interpretation of STf-seienmelnt depression and T-wvave inversion without other characteristic changes, particularly when there is clinical uncertainty regarldiiig the presenmce and nature of an acute coronary attack. A commoni solution, often nnsatisfactory to the clinician receiving the report, is the statement "'The ST-seginent and T-wave changes are nonspecific abnorinali-

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Section: Methodsmentioning

confidence: 99%

"Nonspecific" ST and T-Wave Changes

Friedberg

Zager

1961

Circulation

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“…1). Three patients had post-operative E.C.G.s which indicated probable fresh infarction; in two there was widespread deep symmetrical T-wave inversion of a type known to be associated with subendocardial infarction (Pruitt et al, 1955;Garcia-Palmieri et al, 1956) (Fig. 2), and in the other Age did not appear to be an important factor in determining risk.…”

Section: Methodsmentioning

confidence: 95%

Effects of Surgery Under General Anaesthesia on the Electrocardiogram in Ischaemic Heart Disease and Hypertension

Chamberlain¹,

Edmonds-Seal²

1964

BMJ

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SummaryEighty-one psychotic (" endogenous ") depressions were studied to determine the mode of onset of the symptoms, using a graphic method. Four patterns emerged from this investigation: (1) sudden onset (1 1); (2) gradual onset (50) ; (3) neurotic onset (14) ; and (4) fluctuating onset (6).Groups 1, 2, and 3 were examined further to see if other differences could be found. The results seemed to indicate that group 1 (sudden onset) comprised illnesses that were separate and distinct from those of groups 2 and 3, corresponded to the depressed phase of manic-depressive psychosis, and were truly endogenous; while the depressions of groups 2 and 3 were mainly exogenous, and, though probably related to each other, showed different responses to antidepressive drugs, group 2 responding more consistently.A classification of psychotic depressive illnesses, based on the evidence presented, is set out.

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“…1-7 In addition, such an ECG presentation has been documented along with a total occlusion of the first diagonal branch, in which case it represents subendocardial ischemia of the border zone surrounding the area of mid-anterior transmural ischemia; it is recorded in leads V4-V5 and sometimes in V3 along with STE in leads aVL and V2 and sometimes in I. [2][3][4][5]8 This ECG pattern has been presented by Pruitt et al 9 whereas, later on, De Servi et al 10 recorded it following ergometrine maleateinduced subtotal LADA occlusion. Sclarovsky et al 2 showed that 86% of the patients with precordial STD and positive T wave had a significant LADA or diagonal branch stenosis.…”

Section: Commentmentioning

confidence: 96%

Preinfarction angina entailing precordial ST segment depression with positive T wave

Ανδρέου

Georgiou

Avraamides

2011

Journal of Cardiovascular Medicine

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A 46-year-old male, cigarette smoker with dyslipidemia was admitted because of atypical chest pain associated with nonspecific T wave abnormalities in leads III and aVF. Serial cardiac enzyme evaluation, including troponin, was negative and he was discharged home following absence of exercise-induced ischemia. Three days later, he was readmitted because of acute rest angina. His ECG recorded during pain displayed a heart rate (HR) of 68 beats/min, ST segment depression (STD) with positive and peaked T waves in leads I, II, aVL and V2-V6 and absence of ST segment elevation (STE) in the posterior leads (Fig. 1a). Medical therapy resulted in abolishment of angina and STD resolution, but inverted T waves in leads III and aVF. About 1 h later, angina recurred in association with STD and peaked positive T waves in leads V2-V6, loss of R wave in V2, a Q wave in V3, subtle STE in lead III, pseudonormalization of the T wave in aVF and STD in I and aVL (Fig. 1b). Echocardiography during this phase displayed left anterior descending artery (LADA)-related segmental akinesia. Angina continued despite maximally tolerated medical therapy and provided the acute ischemic ECG changes, we recommended urgent coronary angiography. However, the patient expressed his preference to have this examination done in a private hospital, thus immediate transfer was arranged. Unfortunately, a precatheterization ECG was not performed, but provided that the angiogram displayed a total proximal LADA occlusion (Fig. 2) without collateral flow, we presumed that the ECG showed an STE pattern. The left circumflex (LCx) artery contained an intermediate proximal stenosis, whereas the dominant right coronary artery (RCA) was free of atherosclerosis (Fig. 2). The LADA was successfully tackled with a sirolimus-eluting stent. Creatine kinase and creatine kinase-myocardial band isoenzyme peaked at 3127 IU/l (reference value: 26-171 IU/l) and 247 IU/l (reference value: 0-25 IU/l), respectively. The patient was discharged home following a 6-day uneventful hospital course and ECG evidence of a Q wave anterior myocardial infarction (MI) (Fig. 3). The dobutamine stress echocardiogram performed to assess the functional significance of the LCx artery stenosis was negative, thus this lesion was deferred. CommentThe ECG pattern of precordial STD with positive T wave is an unusual manifestation of acute ischemic heart disease. It has been ascribed to regional subendocardial ischemia of the anterior wall produced by a subtotal occlusion or total occlusion with collateral flow of the LADA, in which case it is maximally recorded in leads V2-V4. [1][2][3][4][5][6][7] In addition, such an ECG presentation has been documented along with a total occlusion of the first diagonal branch, in which case it represents subendocardial ischemia of the border zone surrounding the area of mid-anterior transmural ischemia; it is recorded in leads V4-V5 and sometimes in V3 along with STE in leads aVL and V2 and sometimes in I. [2][3][4][5]8 This ECG pattern has been presented by Pruitt e...

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Certain Clinical States and Pathologic Changes Associated with Deeply Inverted T Waves in the Precordial Electrocardiogram

Cited by 69 publications

References 5 publications

"Nonspecific" ST and T-Wave Changes

"Nonspecific" ST and T-Wave Changes

Effects of Surgery Under General Anaesthesia on the Electrocardiogram in Ischaemic Heart Disease and Hypertension

Preinfarction angina entailing precordial ST segment depression with positive T wave

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