title: Unusual ECG responses to exercise stress testing.
abstract: We describe the case of a patient with coronary artery disease who developed transient ST-segment depression, right bundle branch block (RBBB), left anterior hemiblock, ST-segment elevation +ST), and "giant" T-waves in her electrocardiogram (ECG), an assortment of ECG patterns heretofore unreported in conjunction with exercise stress testing (EST). The amplitude of the +ST was modulated by the superimposed RBBB, as was shown by its augmentation after the abrupt disappearance of RBBB. Following recession of the latter "giant" T-waves, which usually are encountered in the hyperacute phase of myocardial infarction, developed and persisted late in the recovery period. Cardiac enzymes after EST were negative, and arteriography revealed a stenotic left anterior descending coronary artery. The present case indicates that a variety of ECG expressions of severe transmural ischemia or myocardial infarction can also be manifest in the course of EST; this also suggests a common pathophysiological mechanism in severe EST-triggered ischemia and the early phase of myocardial infarction.
authors.affiliation: Division of Cardiology, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, NY 11373, USA. madiasj@nychhc.org
authors.forename: J E
authors.initials: JE
authors.lastname: Madias
authors.forename: H
authors.initials: H
authors.lastname: Agarwal
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006327:Heart Block / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology