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Gepubliceerd in: Netherlands Heart Journal 2/2022

Open Access 15-09-2021 | Image Puzzle – Answer

A ‘fishy’ ECG in a patient with chest pain

Auteurs: V. Devesa Neto, J. M. Santos, J. G. Pereira, L. Ferreira Santos, B. Marmelo

Gepubliceerd in: Netherlands Heart Journal | Uitgave 2/2022

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Answer

The triangular QRS-ST‑T waveform (TW) pattern, also called ‘tombstone’ or ‘graveyard’ and more recently ‘shark fin’ pattern, is a rare electrocardiography pattern that is associated with a poor prognosis in patients with ST-segment elevation myocardial infarction [13]. The ECG (Fig. 1 in the question) showed supraventricular tachycardia and an anterior TW pattern. Echocardiography at hospital admission revealed changes in segmentary motility of the left ventricle corresponding with descending artery territory, and the left ventricular systolic function was severely reduced. No evidence of mechanical complications was found. The patient was referred to urgent coronary angiography, which revealed occlusion of the ostial left anterior descending artery (Fig. 2). After multiple unsuccessful attempts to cross the thrombotic lesion with the guidewire, the patient had another cardiopulmonary arrest. ‘Life-saving’ intracoronary fibrinolysis with alteplase during resuscitation manoeuvres was attempted, without success.
A TW pattern is an unusual finding as these patients usually die rapidly, before being able to get medical assistance and before an ECG is recorded. It is of the utmost importance that medical personnel recognise this pattern immediately, because this allows for an urgent response, including early reperfusion.

Conflict of interest

V. Devesa Neto, J.M. Santos, J.G. Pereira, L.F. Santos and B. Marmelo declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Literatuur
1.
go back to reference Cipriani A, D’Amico G, Brunello G, et al. The electrocardiographic “triangular QRS-ST‑T waveform” pattern in patients with ST-segment elevation myocardial infarction: Incidence, pathophysiology and clinical implications. J Electrocardiol. 2018;51:8–14. CrossRef Cipriani A, D’Amico G, Brunello G, et al. The electrocardiographic “triangular QRS-ST‑T waveform” pattern in patients with ST-segment elevation myocardial infarction: Incidence, pathophysiology and clinical implications. J Electrocardiol. 2018;51:8–14. CrossRef
3.
go back to reference Tarantino N, Santoro F, Brunetti ND. Triangular “shark fin-like” ST modification in takotsubo syndrome: challenging the concept of ST-elevation patterns without coronary occlusion? J Electrocardiol. 2018;51:1157–8. CrossRef Tarantino N, Santoro F, Brunetti ND. Triangular “shark fin-like” ST modification in takotsubo syndrome: challenging the concept of ST-elevation patterns without coronary occlusion? J Electrocardiol. 2018;51:1157–8. CrossRef
Metagegevens
Titel
A ‘fishy’ ECG in a patient with chest pain
Auteurs
V. Devesa Neto
J. M. Santos
J. G. Pereira
L. Ferreira Santos
B. Marmelo
Publicatiedatum
15-09-2021
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 2/2022
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-021-01632-0

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