Appearance of electrocardiographic initial U-wave inversion dependent on pressure-induced early diastolic impairment in patients with hypertension.
BACKGROUND
ECG U-wave inversion can be classified as initial and terminal U inversion according to the phasic relationship to positive U-wave deflection. Initial U inversion is occasionally observed in hypertensive patients while terminal U inversion frequently appears during severe myocardial ischemia.


OBJECTIVE
The genesis of initial U inversion may be related to pressure-induced diastolic dysfunction.


METHODS
In order to clarify the genesis of initial U-wave inversion we studied 11 consecutive hypertensive patients with both initial U inversion and impaired left ventricular early relaxation who were evaluated using Doppler echocardiography.


RESULTS
The U inversion disappeared during acute pressure lowering by sublingual administration of nitroglycerin. The U inversion also disappeared and relaxation improved significantly after chronic blood pressure lowering. Initial U inversion reappeared during a cold pressor test.


CONCLUSIONS
The appearance of initial U inversion was dependent on the pressure-induced impaired left ventricular early relaxation in hypertensive patients.
Miwa
Kunihisa
K
Department of Internal Medicine, Nanto Family and Community Medical Center, Toyama 939-1518, Japan. miwa.kunihisa@city.nanto.lg.jp
D000328:Adult; D000368:Aged; D003080:Cold Temperature; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D011237:Predictive Value of Tests; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
D014665:Vasodilator Agents; D005996:Nitroglycerin