Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves

In a patient with variant angina of the proximal left anterior descending coronary artery, myocardial ischemia changed the QRS-ST-T configurations without J-waves into those resembling "lambda" waves at maximal ST-segment elevation, and couplets or triplets of supraventricular extrasystole...

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Bibliographic Details
Published in:Internal Medicine 2021/05/01, Vol.60(9), pp.1409-1415
Main Authors: Takahashi, Koji, Sakaue, Tomoki, Yamashita, Mina, Enomoto, Daijiro, Uemura, Shigeki, Okura, Takafumi, Ikeda, Shuntaro, Yamamura, Nobuhisa, Ikeda, Kaori
Format: Article
Language:English
Subjects:
Angina
Angina pectoris
Case Report
Coronary artery
Internal medicine
Ischemia
lambda wave
left anterior fascicular block
left septal fascicular block
Morphology
Myocardial ischemia
proximal left anterior descending coronary artery
Tachyarrhythmia
Tachycardia
transmural conduction delay
variant angina
Ventricle
Waves
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Summary:In a patient with variant angina of the proximal left anterior descending coronary artery, myocardial ischemia changed the QRS-ST-T configurations without J-waves into those resembling "lambda" waves at maximal ST-segment elevation, and couplets or triplets of supraventricular extrasystole (SVE) changed the ischemia-induced "lambda" waves into QRS-ST-T configurations resembling a "tombstone" morphology or "monophasic QRS-ST complex." At the resolution phase of coronary spasm, the QRS-ST-T configurations returned to those without J-waves and were changed by SVE into "lambda" waves. Interestingly, neither ischemia- nor SVE-induced "lambda" waves or SVE-induced "tombstone" morphology or "monophasic QRS-ST complex" were complicated by ventricular tachyarrhythmia.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.6197-20