title: Pattern of crescendo TWA may disclose the underlying cardiac pathology.
abstract: 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.
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. tuomo.nieminen@iki.fi
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
authors.forename: Richard L
authors.initials: RL
authors.lastname: Verrier
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Jari
authors.initials: J
authors.lastname: Viik
authors.forename: Rami
authors.initials: R
authors.lastname: Lehtinen
authors.forename: Terho
authors.initials: T
authors.lastname: Lehtimäki
authors.forename: Willi
authors.initials: W
authors.lastname: Kaiser
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
mesh_terms: 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