SHARK FIN ECG PATTERN IN A PATIENT WITH TAKOTSUBO SYNDROME – CASE STUDY AND LITERATURE REVIEW

心脏病学 医学 内科学 心源性休克 QRS波群 心室颤动 ST段 射血分数 心电图 心肌梗塞 T波 ST高程 心力衰竭
作者
Waldemar Elikowski,Patryk Szczęśniewski,Natalia Fertała,Magdalena Zawodna-Marszałek,Joanna Albrecht,Marcin Żytkiewicz
出处
期刊:Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 卷期号:51 (5): 575-580
标识
DOI:10.36740/merkur202305119
摘要

Shark fin or triangular QRS-ST-T waveform ECG pattern, also known as lambda-wave ST elevation or giant R wave syndrome, is a particular ECG presentation where QRS complex, ST-segment and T-wave are fused in a unique complex. Originally described in some patients with ST-segment elevation myocardial infarction (STEMI) during the acute phase, it has been found to be associated with a high risk of ventricular fibrillation and cardiogenic shock as well as with a high in-hospital mortality. However, shark fin ECG pattern has also been reported in patients with non-acute coronary syndrome related ST-elevation (NASTEP), including stress-induced takotsubo syndrome (TTS). Fourteen such cases (all females) have been reported so far. The authors present a case of a 56-year-old male with shark fin ECG pattern associated with TTS triggered by burn injuries of head, back, upper, lower limbs and the respiratory tract. Due to respiratory insufficiency and heart failure with hemodynamic compromise, he required mechanical ventilation and catecholamines use. Echocardiography showed apical and midventricular akinesia with left ventricular ejection fraction and global longitudinal strain reduced to 30% and -6.8%, respectively and a high segmental post-systolic index. Shark fin pattern maintained within 2 days, then ST-T evolution was observed. Echocardiographic improvement followed by almost normalization were seen after 6 and 9 days, respectively. No cardiac arrhythmias were recorded as in most of the described cases with shark fin ECG and TTS.

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