Canyon T Waves Seen as Narrowing of Anterolateral T-Wave Inversions in a Patient With Recurrent Chest Pain Presumed to Be Due to Anterolateral Ischemia
Serial lead V5 tracings were obtained from a 38-year-old woman with long-standing systemic lupus erythematosis, hypertension, and renal failure. On December 12, 1994, the patient was admitted for severe right lower abdominal pain, underwent exploratory laparotomy and diverting ileostomy, and was found to have Clostridium difficile pseudomembranous colitis. The next day (December 13, 1994), she experienced chest pain with dyspnea. A wall motion abnormality was seen on the echocardiogram, but there was no rise in serum creatine phosphokinase levels. On the basis of her symptoms and the new T-wave inversions, on December 15 she was diagnosed clinically as having had myocardial ischemia. Another episode of chest pain the evening of December 20 was relieved by sublingual nitroglycerin, and on December 21 her T-wave inversions had deepened. However, a resting sestamibi injection during chest pain failed to demonstrate a perfusion defect. She was discharged but readmitted January 4, 1995, with another episode of squeezing chest pain radiating to her arm and shoulder. Because of deteriorating renal function, she had developed hyperkalemia, which peaked at 6.5 mEq/L on January 4. At this time, the inverted T waves had narrowed markedly (“canyon T waves”). Her serum potassium was quickly brought into the low normal range, and on January 7 the inverted T waves had again widened. The T-wave inversions began to normalize a week later (January 14, 1995).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
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