Giant T Wave Inversion
Report:
Sinus rhythm 74/min
Advanced second degree AV block
Idioventricular rhythm 38/min
Giant T wave inversion
Prolonged QT interval
QTc 0.60”
Comment:
The tracing is virtually pathognomonic of a preceding Stokes-Adams attack. The T waves are large and typically splayed, same as those seen in CVAs or head trauma. They indicate a preceding period of unconsciousness with surprisingly high diagnostic accuracy; I have seen only one case over the years where the patient claimed preserved consciousness at the time of collapse.
The middle of the trace – third and fourth QRS – appears to have conducted sinus beats, one with IVCD and the other (narrower) probably a fusion beat. The second idioventricular QRS is retrogradely conducted, with negative P wave sharply etched on its ST segment.
Below (Fig 10a) is the next day’s tracing, showing 2:1 conduction and either a variable LBBB or ventricular fusion at the beginning and the end.
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