Pattern of crescendo TWA may disclose the underlying cardiac pathology.
We present an exercise test case in which crescendo TWA preceded ventricular tachycardia (VT). The patient was examined due to suspicion of ischemic heart disease. The ST-segment became elevated simultaneously with a distinct alternation in the ST-segment and the first half of the T-wave, and the patient developed polymorphic VT. Coronary angiography disclosed marked stenoses. Earlier reports of TWA in patients with congenital long QT syndrome show a pattern in which the T wave frequently alternates above and below the isoelectric line without concomitant ST-segment changes. In Brugada syndrome patients, the signature ST-T wave pattern is the locus of alternation. Future investigation should elucidate whether specific TWA morphologies may expose underlying heart disease.
Nieminen
Tuomo
T
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. tuomo.nieminen@iki.fi
Verrier
Richard L
RL
Nikus
Kjell
K
Viik
Jari
J
Lehtinen
Rami
R
Lehtimäki
Terho
T
Kaiser
Willi
W
Kähönen
Mika
M
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery