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CONCEALED LONG QT MANIFESTED AS GIANT INVERTED T WAVES
1228 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making CONCEALED LONG QT MANIFESTED AS GIANT INVERTED T WAVES Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-272 Authors: Keith Suarez, Javier Banchs, Cameron J. Simonsen, Baylor Scott and White, Temple, TX, USA
Background: T wave inversion of more than 10 mm is known as a giant inverted T wave. The differential diagnosis includes myocardial ischemia, long QT syndrome and intracranial hypertension. We present a case of concealed long QT syndrome manifested as giant T waves.
Case: A 72 year old male with history of non-ischemic cardiomyopathy and previously normal QT was admitted with worsening heart failure. Dynamic T wave changes were recognized on telemetry. An electrocardiogram was consistent with giant T wave inversions throughout the precordial leads and QTc of 686 ms (Figure 1). The patient developed Torsade de Pointe requiring external cardioversion. Decision Making: Intravenous magnesium and dobutamine were infused. Home medications included amitriptyline and fluoxetine which were discontinued. An echocardiogram revealed an ejection fraction of 40%. Head computed tomography was negative for intracranial disease. Coronary angiography did not show flow limiting coronary artery disease. Cardiac MRI was negative for myocarditis. Genetic testing for long QT syndrome was sent and in the absence of confirmatory diagnosis the patient received an implantable cardioverter defibrillator. Giant T waves and long QT resolved over more than one week. Conclusions: Concealed long QT may manifest as giant T wave inversions and become apparent only after combination or specific QT prolonging drugs. This finding can precede life threatening ventricular arrhythmias.
FIT Clinical Decision Making CONCEALED LONG QT MANIFESTED AS GIANT INVERTED T WAVES Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-272 Authors: Keith Suarez, Javier Banchs, Cameron J. Simonsen, Baylor Scott and White, Temple, TX, USA
Background: T wave inversion of more than 10 mm is known as a giant inverted T wave. The differential diagnosis includes myocardial ischemia, long QT syndrome and intracranial hypertension. We present a case of concealed long QT syndrome manifested as giant T waves.
Case: A 72 year old male with history of non-ischemic cardiomyopathy and previously normal QT was admitted with worsening heart failure. Dynamic T wave changes were recognized on telemetry. An electrocardiogram was consistent with giant T wave inversions throughout the precordial leads and QTc of 686 ms (Figure 1). The patient developed Torsade de Pointe requiring external cardioversion. Decision Making: Intravenous magnesium and dobutamine were infused. Home medications included amitriptyline and fluoxetine which were discontinued. An echocardiogram revealed an ejection fraction of 40%. Head computed tomography was negative for intracranial disease. Coronary angiography did not show flow limiting coronary artery disease. Cardiac MRI was negative for myocarditis. Genetic testing for long QT syndrome was sent and in the absence of confirmatory diagnosis the patient received an implantable cardioverter defibrillator. Giant T waves and long QT resolved over more than one week. Conclusions: Concealed long QT may manifest as giant T wave inversions and become apparent only after combination or specific QT prolonging drugs. This finding can precede life threatening ventricular arrhythmias.