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Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves
Koji Takahashi1,2, Tomoki Sakaue1,2, Mina Yamashita2
1Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan.
Internal Medicine (Tokyo, Japan)
|May 6, 2021
Summary
Variant angina can cause unique ECG changes like "lambda" waves during ischemia. Supraventricular extrasystoles (SVE) can further alter these patterns to "tombstone" shapes without causing dangerous arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Diagnostic Electrocardiography
Background:
- Variant angina, characterized by coronary artery spasm, can lead to myocardial ischemia.
- Electrocardiogram (ECG) changes during ischemia are crucial for diagnosis and management.
- The specific ECG morphologies associated with variant angina and extrasystoles require detailed understanding.
Purpose of the Study:
- To describe novel ECG findings in a patient with variant angina of the proximal left anterior descending coronary artery.
- To investigate the impact of myocardial ischemia and supraventricular extrasystoles (SVE) on QRS-ST-T wave configurations.
- To assess the arrhythmogenic potential of observed ECG changes.
Main Methods:
- Case study of a patient diagnosed with variant angina.
- Continuous electrocardiographic monitoring during episodes of ischemia and SVE.
- Analysis of QRS-ST-T wave morphology changes in response to ischemia and SVE.
Main Results:
- Myocardial ischemia induced "lambda" waves during maximal ST-segment elevation.
- Supraventricular extrasystoles (SVE) transformed ischemia-induced "lambda" waves into "tombstone" or monophasic QRS-ST complexes.
- Neither ischemia- nor SVE-induced ECG changes were associated with ventricular tachyarrhythmia.
Conclusions:
- Specific ECG patterns, including "lambda" waves and "tombstone" morphologies, can occur in variant angina.
- These distinct ECG changes induced by ischemia and SVE appear to be non-arrhythmogenic in this case.
- Further research is warranted to understand the prevalence and clinical significance of these ECG findings.
Keywords:
lambda waveleft anterior fascicular blockleft septal fascicular blockproximal left anterior descending coronary arterytransmural conduction delayvariant anginaMore Related Videos
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