title: "Giant R wave" electrocardiogram pattern during exercise treadmill test: A case report.
abstract: BACKGROUND
  The exercise treadmill test is widely used in the evaluation of patients with suspected or known coronary artery disease. The typical ischemic response used to be ST-segment depression.
  
  
  METHODS
  We describe a case of a 51-year-old Caucasian man with an unusual ischemic response during the exercise treadmill test: a "giant R wave" electrocardiogram pattern as a manifestation of hyperacute ischemia that resolved with sublingual nitroglycerin. Coronary catheterization showed a severe stenosis in a proximal dominant circumflex coronary artery. We hypothesize that, in this case, the "giant R wave" pattern was related to severe hyperacute ischemia due to coronary spasm superimposed on the atherosclerotic lesion, which probably caused complete occlusion of the artery. The patient was successfully treated with coronary percutaneous revascularization.
  
  
  CONCLUSIONS
  This is a dramatic and rare ischemic response during the exercise treadmill test, in which, a rapid administration of nitroglycerin can prevent life-threatening events.
authors: Department of Cardiology, Hospital Lucus Augusti, San Cibrao s/n, Lugo E-27003, Spain. ana.testa.fernandez@gmail.com.
authors: Ana
authors: A
authors: Testa-Fernández
authors: Ramón
authors: R
authors: Rios-Vazquez
authors: Juan
authors: J
authors: Sieira-Rodríguez-Moret
authors: Raúl
authors: R
authors: Franco-Gutierrez
authors: Carlos
authors: C
authors: Peña-Gil
authors: Ruth
authors: R
authors: Pérez-Fernández
authors: Victor
authors: V
authors: Puebla-Rojo
authors: Margarita
authors: M
authors: Regueiro-Abel
authors: Carlos
authors: C
authors: Gonzalez-Juanatey