Hidden Fatal ECG Manifestations

Abstract

This case report presents the electrocardiogram findings of a patient in their 50s with syncope and palpitation and amaurosis followed by loss of consciousness for several minutes without preceding position change, cough, chest pain, or shortness of breath.

ST-T Alternans in Acute Myocardial Infarction as a Risk Predictor for Fatal Ventricular Arrhythmia

“…The authors highlight that “giant R-wave syndrome is distinguished by delayed depolarization and repolarization of the myocardium, which is a predictor of the onset of ventricular fibrillation.” The authors focused only on giant R-wave syndrome as a predictive factor for ventricular arrhythmias in patients with acute myocardial infarction and ignored the presence of cardiac electrical alternances. Obvious in the Holter recording (Figure in the case report) is a clear macro–ST-T–wave alternans observed in leads V 2 through V 4 . Therefore, it is reasonable to conclude that, in addition to the presence of giant R-wave syndrome, the electrical alternans of ST-T may play a more crucial role in polymorphic ventricular tachycardia .…”

“…To the Editor Xu et al present the electrocardiogram findings of a patient in their 50s with syncope and palpitation and amaurosis, followed by loss of consciousness for several minutes without preceding position change, cough, chest pain, or shortness of breath. The authors highlight that “giant R-wave syndrome is distinguished by delayed depolarization and repolarization of the myocardium, which is a predictor of the onset of ventricular fibrillation.” The authors focused only on giant R-wave syndrome as a predictive factor for ventricular arrhythmias in patients with acute myocardial infarction and ignored the presence of cardiac electrical alternances. Obvious in the Holter recording (Figure in the case report) is a clear macro–ST-T–wave alternans observed in leads V 2 through V 4 .…”

ST-T Alternans in Acute Myocardial Infarction as a Risk Predictor for Fatal Ventricular Arrhythmia—Reply

“…In our case report, we aimed to emphasize the significance of considering CAD as a potential cause of syncope in susceptible patients, even in the absence of chest pain or acute coronary syndrome. Several parameters have been associated with ventricular arrhythmias in ischemic heart disease, such as the duration of episodes, extent of ST-segment elevation, presence of giant R-wave syndrome, STTA, and a greater than 25% increase of the R wave .…”

“…Several parameters have been associated with ventricular arrhythmias in ischemic heart disease, such as the duration of episodes, extent of ST-segment elevation, presence of giant R-wave syndrome, STTA, and a greater than 25% increase of the R wave . However, in this case, the patient exhibited giant R-wave syndrome, premature beats from Purkinje fibers, and subsequent PMVT. Notably, the absence of reported chest pain led us to define the condition as CAD rather than specifically diagnosing Prinzmetal angina.…”

“…In Reply We express our gratitude to Zhao and Wang for their interest in our recent case report in which we detailed polymorphic ventricular tachycardia (PMVT) triggered by premature beats from Purkinje fibers. This occurred within the context of giant R-wave syndrome stemming from coronary artery disease (CAD).…”