Occurrence of Transient U-Wave Inversion During Vasospastic Anginal Attack Is Not Related to the Direction of Concurrent ST-Segment Shift

Kodama-Takahashi, Koji; Ohshima, Kiyotaka; Yamamoto, Kozo; Iwata, Takeru; Hamada, Mareomi; Hiwada, Kunio; Murakami, Eiki

doi:10.1378/chest.122.2.535

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…It is significant when observed post exercise, being originally described in early 1940s. Subsequent studies in the late 1970s, demonstrated a significant correlation of U wave inversion with either left main or LAD disease 2 3 7. It is best observed during recovery from exercise as the heart rate slows, becoming upright after several minutes, which helps to verify the finding 4.…”

Section: Discussionmentioning

confidence: 96%

Significance of exercise induced U wave inversion as a marker for coronary artery disease

Raveendran

Hadfield²,

Petkar³

et al. 2012

Case Reports

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Exercise stress testing for detecting inducible ischaemia was first introduced in the 1950s and remained one of the only methods of stressing the heart for years to come. The presence of inducible ischaemia was assessed by ECG changes during exercise apart from other factors, namely, duration of exercise, blood pressure and heart rate response, metabolic equivalents achieved, etc. With the emergence of other tests to look for inducible ischaemia, for example, dobutamine stress echocardiography and myocardial perfusion scanning and also as the threshold for invasive evaluation has decreased, unusual and infrequently encountered ECG changes are not looked for during exercise stressing with the same degree of diligence. The authors describe below the case of a 49-year-old male whose left anterior descending artery stenosis was diagnosed on exercise stress test on the basis of a negative U wave.

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Section: Discussionmentioning

confidence: 96%

Significance of exercise induced U wave inversion as a marker for coronary artery disease

Raveendran

Hadfield²,

Petkar³

et al. 2012

Case Reports

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“…5 In the early phase of myocardial ischemia that is associated with coronary vasospasm or exercise-induced ischemia, a transient U-wave inversion may occur. 6 It has been described in a few case reports that inverted U-waves might precede the typical electrocardiographic changes of myocardial infarction by several hours. 7 Studies have also shown that, after successful revascularization, the inverted U-waves have disappeared.…”

Section: Discussionmentioning

confidence: 99%

“…Transient inverted U-waves are considered as a specific electrocardiographic sign of myocardial ischemia . In the early phase of myocardial ischemia that is associated with coronary vasospasm or exercise-induced ischemia, a transient U-wave inversion may occur . It has been described in a few case reports that inverted U-waves might precede the typical electrocardiographic changes of myocardial infarction by several hours .…”

Section: Discussionmentioning

confidence: 99%

Inverted U Waves—Red Flags in Electrocardiograms

2023

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“…A positive provocative test with high specificity and sensitivity for coronary artery spasms must induce severe vasoconstriction accompanied by chest pain (typical of the patient’s usual complaint) and ischemic ECG changes in response to the provocative stimulus, such as ergonovine and acetylcholine [ 9 , 16 , 17 ]. The test result is considered equivocal if the provocative stimulus does not induce all three components [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Vasospasm in the First Septal Perforator Branch and Late High-Grade Atrioventricular Block Following Successful Primary Percutaneous Coronary Intervention for the Proximal Left Anterior Descending Coronary Artery: A Case Report

Takahashi¹,

Takemoto²,

Sakaue³

et al. 2023

Cureus

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We present a case of a high-degree advanced atrioventricular block (AVB), which occurred 24 hours after successful primary percutaneous coronary intervention (PCI) in the proximal left anterior descending coronary artery (LAD), the culprit of ST-segment elevation myocardial infarction (STEMI). The methylergometrine provocation test for coronary vasospasms, which was performed on the eighth hospital day, revealed transient total occlusion of the first septal perforator branch. After prescribing a calcium channel blocker to the patient, AVB did not recur for three years, as confirmed using an implantable loop recorder (ILR). In this patient, delayed high-grade AVB following primary PCI in the proximal LAD might be caused by the spasm of the first septal perforator branch. Documented cases of spasms in this branch are rare.

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Occurrence of Transient U-Wave Inversion During Vasospastic Anginal Attack Is Not Related to the Direction of Concurrent ST-Segment Shift

Cited by 10 publications

References 31 publications

Significance of exercise induced U wave inversion as a marker for coronary artery disease

Significance of exercise induced U wave inversion as a marker for coronary artery disease

Inverted U Waves—Red Flags in Electrocardiograms

Vasospasm in the First Septal Perforator Branch and Late High-Grade Atrioventricular Block Following Successful Primary Percutaneous Coronary Intervention for the Proximal Left Anterior Descending Coronary Artery: A Case Report

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