[ST-segment depression and elevation during supraventricular tachycardias]

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Supraventricular tachycardias (SVTs) can present with electrocardiogram (ECG) abnormalities.
• Repolarization abnormalities, such as ST-segment depression and elevation, are known but often poorly understood findings during SVTs.

Observation:

• Three cases of young, healthy individuals experiencing SVTs with significant repolarization abnormalities on ECG are presented.
• One case involved a misdiagnosis of acute coronary syndrome due to pronounced ST-segment depression and elevated troponin I levels.
• Subsequent coronary angiography and echocardiography in the misdiagnosed case revealed no underlying coronary artery disease or structural heart abnormalities.

Findings:

• Repolarization abnormalities during SVTs can be profound and mimic ischemic changes.
• These ECG findings can lead to misdiagnosis of acute coronary syndrome, even with elevated cardiac biomarkers.
• Normal coronary angiogram and echocardiogram findings in a misdiagnosed case highlight the potential for SVT-induced ECG changes.

Implications:

• Emphasizes the need for careful interpretation of ECG findings in the context of SVT, especially in young, healthy populations.
• Suggests that SVT-related repolarization abnormalities may be more common or pronounced than previously recognized.
• Highlights the importance of considering SVT as a potential cause of ST-segment abnormalities and troponin elevation to prevent unnecessary invasive procedures and misdiagnosis.