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Case Reports
. 2024 Mar 12;8(3):ytae123.
doi: 10.1093/ehjcr/ytae123. eCollection 2024 Mar.

Exercise-induced pseudo-ischaemic electrocardiographic changes in a female with concave-shaped chest wall

Andrea Sonaglioni  1 , Gian Luigi Nicolosi  2 , Michele Lombardo  1
Affiliations
Case Reports

Exercise-induced pseudo-ischaemic electrocardiographic changes in a female with concave-shaped chest wall

Andrea Sonaglioni et al. Eur Heart J Case Rep. .
No abstract available

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
(A) L-L thoracic diameter, measured at end inspiration with the individual in the standing position and with open arms, by using a rigid ruler in centimetres coupled to a level (the measuring device), placed at the distal third of the sternum, in the point of maximum depression of the sternum. L-L, latero-lateral. (B) A-P thoracic diameter, obtained with the individual in the left-lateral decubitus position, during conventional transthoracic echocardiography, by placing a 2.5 mHz transducer near the sternum in the left third or fourth intercostal space, to obtain a parasternal long-axis view, and measuring at end inspiration the distance between the true apex of the sector and the anterior surface of the vertebral body. The vertebral body is identified by using, as a reference point, the posterior wall of the descending thoracic aorta, visualized behind the left atrium. Ao, aorta; A-P, antero-posterior; Asc, ascending; Desc, descending; LA; left atrium; LV, left ventricle; MHI, modified Haller index; RV, right ventricle. (C1) Resting electrocardiogram showing sinus rhythm with mild right ventricular conduction delay and non-specific ST-T repolarization abnormalities in the anterolateral leads. (C2) Peak-exercise electrocardiogram showing marked downsloping ST-segment depression in the anterolateral leads V4–V6 (circles) (maximum 2.5 mm in V5). (D) Axial computed tomography scan assessing conventional Haller index, the ratio of chest transverse diameter over the distance between the sternum and spine. (E–L) Computed tomography coronary angiography: curved planar reformation images of left anterior descending artery (E), D1 (F), D2 (G), left circumflex artery (H), right coronary artery (I), and posterior descending artery (L), with no evidence of obstructive coronary artery disease. D1, first diagonal branch; D2, second diagonal branch; LAD, left anterior descending artery; LCx, left circumflex artery; PDA, posterior descending artery; RCA, right coronary artery. (M) Parasternal long-axis view demonstrating bileaflet mitral valve thickening and prolapse (arrows). Ao, aorta; LA, left atrium; LA, left ventricle; RV, right ventricle. (N) Global longitudinal strain bull's eye plot assessed by strain echocardiographic imaging. This example shows a moderate impairment in global longitudinal strain magnitude (−16.6%), secondary to a significant reduction in left ventricular basal strain values, represented as light red, light pink, and pale and/or light blue. GLS, global longitudinal strain; LV, left ventricular.
See this image and copyright information in PMC

References

    1. Sonaglioni A, Baravelli M, Vincenti A, Trevisan R, Zompatori M, Nicolosi GL, et al. . A new modified anthropometric Haller index obtained without radiological exposure. Int J Cardiovasc Imaging 2018;34:1505–1509. - PubMed
    1. Udoshi MB, Shah A, Fisher VJ, Dolgin M. Incidence of mitral valve prolapse in subjects with thoracic skeletal abnormalities—a prospective study. Am Heart J 1979;97:303–311. - PubMed
    1. Boudoulas KD, Pitsis AA, Mazzaferri EL, Gumina RJ, Triposkiadis F, Boudoulas H. Floppy mitral valve/mitral valve prolapse: a complex entity with multiple genotypes and phenotypes. Prog Cardiovasc Dis 2020;63:308–326. - PubMed

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