{"id":491,"date":"2016-03-13T00:01:39","date_gmt":"2016-03-13T00:01:39","guid":{"rendered":"http:\/\/torreyekg.com\/?p=491"},"modified":"2016-02-16T03:50:29","modified_gmt":"2016-02-16T03:50:29","slug":"ekg-of-the-week-23","status":"publish","type":"post","link":"https:\/\/torreyekg.com\/index.php\/2016\/03\/13\/ekg-of-the-week-23\/","title":{"rendered":"EKG of the Week #23"},"content":{"rendered":"

\"23\"<\/a>
\nYoung Iraqi man with atypical chest pain and pre-syncope.<\/p>\n

Answer & Explanation<\/div>

\nSinus rhythm at 66\/minute
\nAxis is 0\u00b0
\nIntervals are normal
\nVoltage is suggestive of LVH with R waves \u2265 12mm in aVL
\nImpressive, deep and symmetrical T wave inversion in multiple leads\n

This striking EKG is typical of an unusual form of hypertrophic cardiomyopathy \u2013 apical hypertrophic cardiomyopathy, or Yamaguchi syndrome. This type of HCM is relatively common in the Japanese population, where it was first described, but occurs rarely in other populations (3% of all hypertrophic cardiomyopathy in the US).<\/p>\n

This seems a good time to review the causes of \u201cgiant inverted T waves\u201d<\/p>\n

    \n
  1. CNS events (particularly SAH)<\/li>\n
  2. Takosubo cardiomyopathy<\/li>\n
  3. Wellen\u2019s syndrome (critical LAD lesion during pain-free period) \u2013 V2-4<\/sub><\/li>\n
  4. Vasospasm<\/li>\n
  5. Hypertrophic cardiomyopathy (particularly apical hypertrophy type)<\/li>\n
  6. Memory T waves with VVI pacing<\/li>\n<\/ol>\n

    Siewe D, et al. King of hearts for ace of spades: apical hypertrophic cardiomyopathy. Am J Med<\/em> 127:31-33, 2014.<\/p>\n

    Yamaguchi H, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy). Am J Cardiol<\/em> 44:401-412, 1979.<\/p>\n

    Pillarisetti J, Gupta K. Giant inverted T waves in the emergency department: case report and review of differential diagnosis. J Electrocardiol <\/em> 43:40-42, 2010.
    \n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

    Young Iraqi man with atypical chest pain and pre-syncope.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-491","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/491","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=491"}],"version-history":[{"count":3,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/491\/revisions"}],"predecessor-version":[{"id":495,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/491\/revisions\/495"}],"wp:attachment":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=491"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=491"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=491"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}