Obscure ST Segment Elevation

Report:

Sinus rhythm

Diffuse ST segment elevation

Possible ischæmia

Comment:

The changes occurred following the aminophylline-induced tachycardia (Fig 129a below). The prominent T waves also suggest ischæmia, but there was no reason to suspect it otherwise. There was no question of cocaine.

One possible explanation, in aminophylline toxicity, is a preceding grand mal convulsion causing “cerebral” repolarisation changes. Again, one would expect the (usually, but not always) prolonged QT interval.

Atypical early repolarisation won the day. At least the background - a disturbed young man – was typical of that.

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