{"id":709,"date":"2017-04-17T00:01:12","date_gmt":"2017-04-17T00:01:12","guid":{"rendered":"http:\/\/torreyekg.com\/?p=709"},"modified":"2017-03-13T14:04:19","modified_gmt":"2017-03-13T14:04:19","slug":"ekg-of-the-week-51","status":"publish","type":"post","link":"https:\/\/torreyekg.com\/index.php\/2017\/04\/17\/ekg-of-the-week-51\/","title":{"rendered":"EKG of the Week #51"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/51.png\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/51.png\" alt=\"\" width=\"691\" height=\"377\" class=\"alignnone size-full wp-image-723\" srcset=\"https:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/51.png 691w, https:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/51-300x164.png 300w\" sizes=\"auto, (max-width: 691px) 100vw, 691px\" \/><\/a><br \/>\n60-year-old woman after an upsetting argument with her daughter.  List at least three things that can look like this.<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Answer &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nThe differential diagnosis of conditions that produce inverted T waves is worth reviewing.  It includes more than ischemia and subendocardial infarction!\n<p>Differential of T-wave inversion<br \/>\n1\u00b0 T-wave changes<br \/>\n\tNormal variants, like juvenile T-wave pattern<br \/>\n\tCNS events (can be impressive, diffuse, and deep)<br \/>\n\tTakotsubo cardiomyopathy<br \/>\n\tCoronary vasospasm<br \/>\n2\u00b0 T-wave changes<br \/>\n\tBundle branch blocks<br \/>\n\tWPW pre-excitation<br \/>\n\tVentricular pacing  (memory T-waves)<br \/>\n\tAcute pulmonary embolism  (especially V1-4)<\/p>\n<p>This woman presented with chest pain and shortness of breath after the stressful argument with her daughter.  She was taken to the cath lab which revealed clean coronary arteries but left ventricular apical ballooning \u2013 Takotsubo cardiomyopathy.<\/p>\n<p>From the differential diagnosis, there are really only four things that can produce such striking, deeply inverted T waves:  coronary vasopspasm, subendocardial ischemia, CNS events (stroke or subarachnoid hemorrhage), and Takotsubo cardiomyopathy.<\/p>\n<p>Hayden GE, Brady WJ, Perron AD, et al.  Electrocardiographic T-wave inversion: differential diagnosis in the chest pain patient. Am J Emerg Med  20:252, 2002.<\/p>\n<p>Prasad A, Lerman A, Rihad CS.  Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.  Am Heart J  155:408, 2008.<\/p>\n<p><\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>60-year-old woman after an upsetting argument with her daughter. List at least three things that can look like this.<\/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-709","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\/709","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=709"}],"version-history":[{"count":3,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/709\/revisions"}],"predecessor-version":[{"id":725,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/709\/revisions\/725"}],"wp:attachment":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=709"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=709"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}