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In our study the ECG abnormalities were sinus tachycardia, T-wave inversion in inferior leads, left anterior hemiblock with left axis deviation and ventricular premature contraction.
Our findings are corroborated by a systematic review and meta-analysis by Qaddoura et al, in which ECG signs that were good predictors of a negative outcome for in-hospital mortality included S1Q3T3 (OR: 3.38, 95% CI: 2.46-4.66, p<0.001), complete right bundle branch block (OR: 3.90, 95% CI: 2.46-6.20, p<0.001), T-wave inversion (OR: 1.62, 95% CI: 1.19-2.21, p=0.002), right axis deviation (OR: 3.24, 95% CI: 1.86-5.64, p<0.001), and atrial fibrillation (OR: 1.96, 95% CI: 1.45-2.67, p<0.001)18.
Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Takotsubo cardiomyopathy.
In a study by Dogan et al., on the other hand, 65% of patients had ischemia-like ECG changes with the most common one being T-wave inversion [16].
Here, we present the case of a 48 year-old female known with mitral valve prolapse (MVP) hospitalized for persistent atypical anterior chest pain, ST-T segment depression and T-wave inversion in inferior and lateral leads suggesting an acute coronary syndrome.
On examination, electrocardiogram revealed sinus tachycardia 92/min and 1 mm ST-segment depression in leads V4-V6 and T-wave inversion in aVL.
A chest radiograph showed borderline cardiomegaly, an electrocardiogram demonstrated diffuse T-wave inversion inferolaterally, and an echocardiogram was normal.
(1) Sinus tachycardia is the most common ECG abnormality in these patients, (4) and T-wave inversion in the precordial leads also is common.
S waves in lead I and Q waves in lead III with T-wave inversion in III); 5) shift in the transition zone (R5S) to V5 or further leftward; 6) complete or incomplete RBBB; 7) peripheral low voltage (in the limb leads); 8) pseudoinfarction pattern (prominent Q waves) in leads III and aVF; 9) ST segment elevation 0.1 mV over the right (V2-V3) or the left (V4-V6) precordial leads; 10) ST segment depression [greater than or equal to] 0.05 mV over the right or the left precordial leads; and 11) T-wave inversion over the right or the left precordial leads.
Peri-procedure, pronounced ST elevation suggestive of myocardial ischaemia manifested on the electrocardiogram lasting for four hours post-procedure, upon which the athlete developed deep and diffuse inferolateral T-wave inversion. These changes resolved spontaneously and the patient remained clinically stable throughout.