Global T Wave Inversion

Report:

Sinus rhythm

Global T wave inversion

Lateral ST segment elevation

Poor R wave progression

Comment:

The striking ECG changes bore no relationship to the patient’s symptoms. There was no evidence of infarction. The ECG normalised and, three weeks later, did it again (Fig 140a below). The patient did, however, have angina pectoris at other times and her angiogram showed 90% LAD stenosis. It would be difficult not to ascribe the ECG changes to ischæmia.

Overpage are CCU strips showing the silent downward progression of her T waves (140b).

There were other loose ends, as often happens in clinical medicine: history of hypertension and a CVA, and unexplained hypercalcæmia (not reflected in her normalised ECG, Fig 140c).

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