tailieunhanh - Báo cáo khoa học: " “Giant R wave” electrocardiogram pattern during exercise treadmill test: A case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: “Giant R wave” electrocardiogram pattern during exercise treadmill test: A case report. | Testa-Fernández et al. Journal of Medical Case Reports 2011 5 304 http content 5 1 304 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Giant R wave electrocardiogram pattern during exercise treadmill test A case report Ana Testa-Fernández Ramón Rios-Vazquez Juan Sieira-Rodríguez-Moret Raúl Franco-Gutierrez Carlos Pena-Gil Ruth Pérez-Fernández Victor Puebla-Rojo Margarita Regueiro-Abel and Carlos Gonzalez-Juanatey Abstract Introduction The exercise treadmill test is widely used in the evaluation of patients with suspected or known coronary artery disease. The typical ischemic response used to be ST-segment depression. Case presentation We describe a case of a 51-year-old Caucasian man with an unusual ischemic response during the exercise treadmill test a giant R wave electrocardiogram pattern as a manifestation of hyperacute ischemia that resolved with sublingual nitroglycerin. Coronary catheterization showed a severe stenosis in a proximal dominant circumflex coronary artery. We hypothesize that in this case the giant R wave pattern was related to severe hyperacute ischemia due to coronary spasm superimposed on the atherosclerotic lesion which probably caused complete occlusion of the artery. The patient was successfully treated with coronary percutaneous revascularization. Conclusions This is a dramatic and rare ischemic response during the exercise treadmill test in which a rapid administration of nitroglycerin can prevent life-threatening events. Introduction A typical ischemic response during an exercise treadmill test ETT is ST-segment depression. ST-segment elevation is present in only about of patients who undergo this test 1 and is more specific for indicating the site of the culprit lesion 2 3 . The giant R wave syndrome was first described by Prinzmetal et al. 4 in the context of variant angina and it is characterized by the appearance of a giant R wave loss of the S wave and merging of the QRS complex with the ST .