Bizarre T-wave inversions, with Negative U-waves and Very long QT. And a myocardial viability study.

This 60-something year old male was admitted and his hospital course complicated by GI bleed, hemodynamic instability, and a nadir hemoglobin less than 5 g/dL.  An ECG was relatively normal.The next AM, his potassium was measured at 2.9 mEq/L, so another ECG was recorded.He was asymptomatic.The previous ECG from one week prior had been relatively normal.There are bizarre inverted T-waves and also inverted U-waves (see the 2nd inverted bump?)The QT is incredibly longThere is some subtle STE in inferior leads but also STE in I, aVL.There is STE before the bizarre TU inversion in leads V3-V6.There are some artifacts that look similar to this.  Bizarre (Hyperacute??) T-wavesInverted U-waves are very strongly associated with LAD occlusion.Besides the Nonspecific T-wave Inversion in aVL, What Else is Abnormal on this ECG?Bizarre T-wave inversion with long QT is typical of takotsubo.Bizarre T-wave Inversions in a Patient without Chest PainI thought he either had acute MI of the LAD, or takotsubo stress cardiomyopathy.  The team obtained an immediate cardiology consult, a stat formal echo, and serial troponins.Troponin I was 4.2 ng/mL.Echo showed: Low normal left ventricular systolic function with an ejection fraction of 52%.Regional wall motion abnormality--akinesis of the apical anterior, mid-anteroseptal, apical septal, apical inferior, and apical lateral segments.Regional wall motion abnormality--hypokinesis of the mid anterolateral and anterior...

Source: Dr. Smith's ECG Blog - July 23, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs