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Giant R wave, convex ST-segment elevation, and negative T wave during exercise treadmill test
1Coronary Care Unit, Hospital Alacros, Spain. jortegacar@wanadoo.es
Journal of Electrocardiology
|August 3, 2004
Summary
Giant R wave syndrome, a marker of acute myocardial ischemia, presented transiently in a patient with variant angina during exercise testing. The study details ECG changes and coronary artery findings, offering insights into ischemic mechanisms.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Giant R wave syndrome is a rare electrocardiogram (ECG) finding associated with acute myocardial ischemia.
- Variant angina (Prinzmetal's angina) involves transient coronary artery spasm causing myocardial ischemia.
Observation:
- A 65-year-old man with variant angina experienced transient giant R wave syndrome during an exercise treadmill test.
- ECG showed dynamic ST segment changes, including convex and concave ST elevation with varying T wave morphologies, correlating with ischemic episodes and recovery.
- Coronary arteriography revealed significant stenosis in the dominant right coronary artery.
Findings:
- The patient exhibited giant R waves, QRS widening, ST segment elevation, and QRS axis deviation during peak exercise.
- Distinct ST segment and T wave patterns were observed during ischemia, recovery, and a spontaneous angina episode.
- Significant coronary artery stenosis was identified as the likely cause of myocardial ischemia.
Implications:
- This case highlights the diverse ECG manifestations of acute transmural myocardial ischemia, including transient giant R wave syndrome.
- Understanding these dynamic ECG changes is crucial for diagnosing and managing ischemic heart disease, particularly variant angina.
- The findings contribute to the understanding of the pathophysiological mechanisms underlying different ST segment and T wave morphologies in acute myocardial ischemia.