The typical ECG changes in ApHCM are called 'giant T-wave
negativity' which is an inverted T-wave
over the precordial lead and often mistaken for acute coronary syndrome.
Caption: Figure 2--Electrocardiogram revealing T-wave
inversions in leads V2 to V4 with ventricular ectopic beats
Data from these published studies summarized that tachycardia, McGinn-White sign (S[sub]1Q[sub]3T[sub]3), right bundle branch block (RBBB), and T-wave
inversion of leads V[sub]1-V[sub]3(TWI) are the most predominant signs of RV strain.,
The inverted T-wave
gradually regains its positivity.
Wellens syndrome was first described in the 1980s by de Zwaan, Wellens, et al, who identified specific T-wave
changes in precordial leads in 14% to 18% of patients with unstable angina who, subsequently, developed a large anterior wall MI .
It was based on scores as in parenthesis: sinus tachycardia (2); incomplete right bundle branch block (2); complete right bundle branch block (3); T-wave
inversion, graded by magnitude (V1 [0 to 2], V2 [1 to 3], V3 [1 to 3], V1 through V4 all inverted 2 mm ); S1Q3T3 complex components (S wave in lead I , Q wave in lead III , inverted T wave in lead III , and the entire S1Q3T3 complex ).
Glancy, "ST-segment depression and T-wave
inversion: classification, differential diagnosis, and caveats," Cleveland Clinic Journal of Medicine, vol.
ECG changes are characterized by ST segment elevation and T-wave
inversion in the right precordial leads in the presence of a structurally normal heart and a normal QT interval.
(2) T peak to T end (Tpe) interval: the peak of the T-wave
as defined as a point of highest amplitude of the T-wave
deflection and the end as a point where the tangent on descending limb of T-wave
intersects the isoelectric line.
Two types of Brugada ECG patterns exist: Type 1 consists of the hallmark "coved-type" ST-segment elevations with negative T-wave
in at least one right precordial lead (V1-V2).
A recent meta-analysis of over 8,000 patients reported sinus tachycardia, T-wave
inversions in lead V1, and ST elevations in aVR to be the most frequent abnormal ECG findings.
Lastly, the delineator locates the onset, the peak, and the end of the P-wave, the QRS complex, and the T-wave
In 50% of the cases, the first change is a high and symmetrical T-wave
which is accompanied by a slight increase of the QT interval, while a negative U-wave will sometimes be seen, followed by a gradual increase of the ST segment, its duration being a few minutes; it coincides with the anginal episode, associated as it is with very high R-waves and severely diminished or absent S-waves followed by the normalization of both the T-wave
and the ST-segment.
The typical ECG findings in this case are an initial ST-segment elevation, followed by the so-called Wellens' pattern characterized by transient T-wave
inversion in the anterior precordial leads and QT interval prolongation (5), which were not observed in our case.
His baseline electrocardiogram (ECG) showed precordial T-wave
inversions in [V.sub.1], [V.sub.2], and [V.sub.3] but no other abnormalities.