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Discusión ECG 2
This tracing shows giant negative T waves in all leads except aVR and V1. The T waves are symmetric, and the QT interval is markedly prolonged. These findings occur most frequently as a result of coronary ischemia or CNS disease. The cause of the finding in this 48-year-old woman, who presented to the Emergency Room in an obtunded state, was a subarachnoid hemorrhage. Giant negative T waves are also found in apical hypertrophic cardiomyopathy but the abnormality is usually restricted to the lateral precordial leads and the QT interval is less prolonged in that condition.
Global T-wave inversion occurs in approximately 0.3% of electrocardiograrns of hospitalized patients- When the amplitude of the inverted T waves exceeds 10 mm in two or more leads, they are termed “giant negative T waves.” WhiIe giant negative T waves are relatively specific for ischemia, CNS disease and apical hypertrophy, more than fifteen etiologies have been associated with global T-wave inversion, including both giant T waves and T waves of lesser arnplitude- About 50% of patients admitted to hospital with global T-wave inversion have a CNS disorder or an acute myocardial infarction. ln the latter case, the onset of T-wave inversion has been associated with reperfusion- Other etiologies include pheochromocytoma, myocarditis, pericarditis, and severe aortic regurgitation- The pattern may occur and remain stable in patients with no known disease. For unknown reasons the pattern has a marked female predorninance.
The negative T wave is usually symmetric. The numerous potential etiologies often can be distinguished with serial electrocardiograms. Scoring credit in this tracing is given for any of the several abnormal repolarization diagnoses on the interpretation list which could be responsible for the deep T-wave inversions. Greatest credit is given for “Suggestive of CNS Disease” because of the patient’s history, and because this tracing shows a markedly prolonged QT interval and a slow sinus rate, which are usually also present in patients with intracranial bleeds.
Agetsuma H, Hirai M, Hirayama H, et al.
Transient giant negative T wave in acute anterior myocardial infarction predicts
R-wave recovery and preservation of left ventricular function. Heart 1996;75:229-34.
Walder LA, Spodick DH. Global T-wave inversion. J Am Coll Cardiol 1991;17:1479-85.
Yamaguchi H, Ishimura T, Nishiyama S, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol 1979;44:401-12.
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