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. 2012 Dec 1;7(4):e93-e96.
doi: 10.1016/j.jccase.2012.10.012. eCollection 2013 Apr.

Exercise-related QT interval shortening with a peaked T wave in a boy with MEN 2 syndrome

Mutlu Gungor  1 , Ozcan Ozeke  2 , Sabri Sayinalp  3 , Cagatay Ertan  2 , Ahmet Duran Demir  2 , Gurler Ilicin  1 , Can Ozer  1
Affiliations

Exercise-related QT interval shortening with a peaked T wave in a boy with MEN 2 syndrome

Mutlu Gungor et al. J Cardiol Cases. .

Abstract

Multiple endocrine neoplasia 2 (MEN 2) is a hereditary syndrome associated with medullary thyroid carcinoma, pheochromocytoma (PCC), and hyperparathyroidism. PCCs in patients with MEN 2 are usually found in the adrenals after the manifestation of medullary thyroid cancer and are commonly bilateral and hormonally active. Unfortunately, a diagnosis of MEN 2 or PCC often is delayed until after the patient has developed an advanced MEN 2-related tumor. We present unusual electrocardiographic changes on exercise testing in MEN 2 syndrome. Transient peaked T waves and shortening QT during exercise stress testing may provide an early clue for undiagnosed PCC. <Learning objective: Stress testing is not just for the diagnosis of ischemia but it may be used to evaluate patients with symptoms that suggest exercise-induced arrhythmias. The pheochromacytoma is a disorder characterized by excess of catecholamines and is usually difficult to diagnose. Excessive sympathetic stimulation is toxic to myocytes and this toxicity may reveal itself as ECG changes such as peaked T waves and shortening of QT interval. Such changes on ECG during sympathetic stimulation such as exercise testing should raise the suspicion of pheochromacytoma.>.

Keywords: Exercise-induced arrhythmia; MEN syndrome.

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Figures

Fig. 1
Fig. 1
Electrocardiogram showing normal sinus rhythm at pretest.
Fig. 2
Fig. 2
Electrocardiogram showing usual sinus tachycardia at peak exercise.
Fig. 3
Fig. 3
Electrocardiogram showing prominent peaked T waves with shortening of QT interval at first minute of the recovery phase.
Fig. 4
Fig. 4
Electrocardiogram showing prominent peaked T waves with shortening of QT interval at second minute of the early recovery phase.
Fig. 5
Fig. 5
Electrocardiogram showing normalization of rhythm at the end of the test.
See this image and copyright information in PMC

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