title: Electrocardiographic T-wave changes underlying acute cardiac and cerebral events.
abstract: T-wave inversions produced by myocardial infarction (MI) are classically narrow and symmetric. Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology. We present a series of cases that presented with different electrocardiography T-wave changes. The first case involved a 64-year-old woman who presented to the emergency department with diffuse splayed T-wave inversions and was found to have an MI in the context of an acute cerebrovascular accident. We contrasted this case with that of a 76-year-old man with hypercholesterolemia who presented with T-wave widening and a prolonged QT interval and was found to have a subarachnoid hemorrhage secondary to a basilar aneurysm and no MI. Several mechanisms have been suggested to explain the cardiac and cerebral injury, including microvascular spasm and increased levels of circulating catecholamines. Accurate interpretation of T-wave changes can assist the clinician toward a timely therapeutic intervention and accurate diagnosis.
authors.affiliation: North Shore University Hospital, Manhasset, NY 11030, USA. jncatanzaro@yahoo.com
authors.forename: John N
authors.initials: JN
authors.lastname: Catanzaro
authors.forename: Perwaiz M
authors.initials: PM
authors.lastname: Meraj
authors.forename: Shuyi
authors.initials: S
authors.lastname: Zheng
authors.forename: Gregory
authors.initials: G
authors.lastname: Bloom
authors.forename: Marie
authors.initials: M
authors.lastname: Roethel
authors.forename: Amgad N
authors.initials: AN
authors.lastname: Makaryus
mesh_terms: D000208:Acute Disease; D000368:Aged; D001488:Basilar Artery; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis