Differential Diagnosis of New Giant T-Wave Inversions

To the Editor The electrocardiogram (ECG) presented by Dr Cai and colleagues is indeed a great challenge. Two days after a fall, an older patient was admitted to the hospital with a hip fracture that was treated by external fixation and skin traction. On hospital day 2, the patient suddenly lost consciousness. An ECG immediately performed showed giant negative T waves (>20 mm) in the precordial leads and a QTc prolongation of 535 milliseconds. Cardiac troponin was elevated. Findings of computed tomography and magnetic resonance imaging (performed because of neurologic deficits) showed bilateral multifocal subacute ischemic stroke. A cardiologist and a neurologist were consulted, and the ECG changes were attributed to the cerebrovascular event. However, results of echocardiography, coronary angiography, ECG monitoring, and carotid ultrasonography were not reported, and the cause of stroke remains undefined.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research