Giant R wave, convex ST-segment elevation, and negative T wave during exercise treadmill test.
The giant R wave syndrome is characterized by giant R wave accompanied by widening of the QRS complex, marked ST segment elevation, QRS axis deviation, and the formation of monophasic QRS-ST complex with obliteration of S wave in leads facing the ischemic zone. This report describes a 65-year-old-man with variant angina who had a transient giant R wave syndrome during an exercise treadmill test. Initially, at peak exercise, there was a convex ST segment elevation ending in a negative T wave in the same (inferior) leads which showed giant R waves. Later, in the recovery period and coinciding with an amelioration of myocardial ischemia, there was a less marked increase of R wave amplitude associated with concave ST segment elevation and positive T wave in the inferolateral leads. Subsequently, a ST segment depression in the inferolateral leads preceded the ECG normalization. The patient had also a concave ST segment elevation and positive T wave in inferolateral leads during a spontaneous episode of variant angina at rest. An emergency coronary arteriography showed a dominant right coronary artery with an 80% and a 75% diameter stenosis of the middle and distal segment, respectively; the other arteries and left ventriculogram were normal. The underlying mechanisms of the different shapes of ST segment elevation and T waveform in the setting of acute transmural myocardial ischemia are discussed.
Coronary Care Unit, Hospital Alacros, Spain. jortegacar@wanadoo.es
Julián
J
Ortega-Carnicer
D000368:Aged; D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D011859:Radiography