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Case Reports
. 2020 Apr 25;4(3):1-6.
doi: 10.1093/ehjcr/ytaa076. eCollection 2020 Jun.

The electrocardiographic 'triangular QRS-ST-T waveform' pattern: a marker of severe haemodynamic compromise in Takotsubo syndrome-a case report

Tuukka Joki  1 , Kjell Nikus  2 , Jari Laukkanen  3
Affiliations
Case Reports

The electrocardiographic 'triangular QRS-ST-T waveform' pattern: a marker of severe haemodynamic compromise in Takotsubo syndrome-a case report

Tuukka Joki et al. Eur Heart J Case Rep. .

Abstract

Background: Takotsubo cardiomyopathy is characterized by transient regional systolic dysfunction of the left ventricle, mimicking myocardial infarction. Although systolic left ventricular (LV) function normalizes in most cases, the outcome is not always favourable. Recently, a rare electrocardiogram (ECG) finding, lambda wave ST elevation or 'triangular QRS-ST-T waveform', was suggested as a possible marker of poor outcome in Takotsubo patients.

Case summary: After a brief episode of chest pain and shortness of breath, a 67-year-old woman developed cardiogenic shock. Her resting ECG showed widespread ST elevations, which soon evolved into a pattern of triangular QRS-ST-T waveforms in the inferior leads and V3-V6. Emergent coronary angiography was normal. The ejection fraction was 20% with apical ballooning and an LV thrombus. At 1-month follow-up, the patient was asymptomatic and the ECG showed only T-wave inversions.

Discussion: The triangular QRS-ST-T waveform ECG pattern has recently been introduced as a high-risk marker in the Takotsubo syndrome.

Keywords: Cardiogenic shock; Case report; High-risk ECG; QRS-ST-T waveform; ST elevation; Takotsubo.

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Figures

Figure 1
Figure 1
Electrocardiogram in the health centre and at hospital admission.
Figure 2
Figure 2
Angiography of the left coronary artery.
Figure 3
Figure 3
Optical coherence tomography findings of the left main and left anterior descending coronary artery.
Figure 4
Figure 4
Electrocardiogram and echocardiography in the intensive care unit. There is thrombus in the left ventricular apex.
Figure 5
Figure 5
Electrocardiogram at 1-month follow-up.
None
See this image and copyright information in PMC

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