1
|
Caccioppola A, Russo FM, Molho E, Fargione L, Guareschi A, Colombo F, Jachetti A. Shark fin ECG pattern in a patient with acute ascending aortic dissection. Int J Emerg Med 2024; 17:154. [PMID: 39390376 PMCID: PMC11465929 DOI: 10.1186/s12245-024-00732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024] Open
Abstract
The 'shark-fin' ECG-sign is a rare electrocardiographic pattern seen in ACS, typically associated with poor prognosis. However, its manifestation in acute aortic syndromes remains largely unexplored. Here, we present a case of a patient diagnosed with Ascending Aortic Dissection, who presented to ED with acute chest pain and shark-fin ECG-pattern.
Collapse
Affiliation(s)
- Alessio Caccioppola
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Filippo Maria Russo
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Enrico Molho
- Department of Clinical Sciences and Community Health, University of Milan, Milan, MI, Italy
| | - Lorenzo Fargione
- Department of Clinical Sciences and Community Health, University of Milan, Milan, MI, Italy
| | - Alessandro Guareschi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, MI, Italy
| | - Federico Colombo
- Cardiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Alessandro Jachetti
- Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy.
| |
Collapse
|
2
|
Wattanachayakul P, Jones C, Malin J, Mohan N, Manzano JM, Akuna E, Amanullah A. Shark fin sign: A rare EKG finding in a patient with Takotsubo cardiomyopathy from influenza A infection. Clin Case Rep 2024; 12:e9158. [PMID: 39156202 PMCID: PMC11329839 DOI: 10.1002/ccr3.9158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 08/20/2024] Open
Abstract
This case demonstrated the rare "shark fin" ECG pattern, an ST-segment elevation typically seen in acute myocardial infarction. We reported a case of takotsubo cardiomyopathy secondary to influenza A infection with multiple organ failure, showing the shark fin sign and resulting in in-patient mortality and various complication.
Collapse
Affiliation(s)
- Phuuwadith Wattanachayakul
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Colton Jones
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - John Malin
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Nandakumar Mohan
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jose Martinez Manzano
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Emmanuel Akuna
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Division of Cardiovascular DiseaseJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Aman Amanullah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Division of Cardiovascular DiseaseJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
3
|
Abstract
This case report describes a patient in their 60s with shortness of breath who tested positive for COVID-19.
Collapse
Affiliation(s)
- Richard Pham
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Takahiro Tsushima
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | |
Collapse
|
4
|
Elikowski W, Szczęśniewski P, Fertała N, Zawodna-Marszałek M, Albrecht J, Żytkiewicz M. SHARK FIN ECG PATTERN IN A PATIENT WITH TAKOTSUBO SYNDROME - CASE STUDY AND LITERATURE REVIEW. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:575-580. [PMID: 38069861 DOI: 10.36740/merkur202305119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Natalia Fertała
- DEPARTMENT OF INTERNAL MEDICINE, JÓZEF STRUŚ HOSPITAL, POZNAŃ, POLAND
| | | | | | - Marcin Żytkiewicz
- DEPARTMENT OF INTERNAL MEDICINE, JÓZEF STRUŚ HOSPITAL, POZNAŃ, POLAND
| |
Collapse
|
5
|
Schreiber A, Inciong K, Ji W, Bauzon JS, Al-Taweel O, Nasser K, Chokshi B, Diep J, Ahsan CH. A single-center retrospective study on the incidence and clinical significance of the electrocardiographic "Triangular QRS-ST-T Waveform" pattern*. Heart Lung 2022; 56:86-90. [PMID: 35809406 DOI: 10.1016/j.hrtlng.2022.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The triangular QRS-ST-T waveform is a rare presentation of ST-segment elevation acute myocardial infarction associated with a poor in-hospital prognosis. OBJECTIVE To evaluate the incidence and clinical implications of the QRS-ST-T waveform pattern. METHODS Clinical data from non-pregnant adult patients who presented as STEMI activations at a single institution between 2017 and 2021 were reviewed. Patients who met electrocardiographic criteria for triangular QRS-ST-T waveform - a giant wave from the fusion of the QRS complex, the ST-segment, and the T-wave - were included in the study. RESULTS There were 417 STEMI activations, eight (1.9%) of which fulfilled the criteria for the triangular QRS-ST-T waveform pattern on electrocardiography. Coronary angiography was performed in five of these patients, four of whom demonstrated a significant lesion to the left anterior descending artery. Three patients did not undergo angiography secondary to hemodynamic instability. Seven of the patients in our study experienced cardiogenic shock requiring vasopressor, inotropic, and/or mechanical support. Only two patients survived to discharge; one was successfully bridged to coronary artery bypass grafting via intra-aortic balloon pump, while the other underwent a staged percutaneous coronary intervention. CONCLUSIONS The triangular QRS-ST-T waveform pattern is a rare ECG finding that may indicate hyper-acute STEMI and is an ominous sign of impending hemodynamic instability. Patients who survived received prompt aggressive therapeutic management.
Collapse
Affiliation(s)
- Ariyon Schreiber
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), Las Vegas, NV.
| | - Kim Inciong
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Wilbur Ji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), Las Vegas, NV
| | - Justin S Bauzon
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Omar Al-Taweel
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Keaton Nasser
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Binna Chokshi
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Jimmy Diep
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Chowdhury H Ahsan
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| |
Collapse
|
6
|
Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. IJC HEART & VASCULATURE 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
Collapse
Affiliation(s)
- Anastasiia V. Bairashevskaia
- Department of Paediatrics, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y. Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R. Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S. Rudnova
- International School “Medicine of the Future”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S. Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I. Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I. Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| |
Collapse
|
7
|
Andreou AY, Christou T, Koskina LE. Electrocardiographic presentation of acute left main coronary artery occlusion misinterpreted as ventricular tachycardia. J Electrocardiol 2021; 68:7-10. [PMID: 34265477 DOI: 10.1016/j.jelectrocard.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
We present a case of acute left main coronary artery (LMCA) occlusion that manifested cardiogenic shock and an ST-segment elevation myocardial infarction (STEMI) electrocardiographic (ECG) pattern comprising "triangular" or "lambda-like" QRS-ST-T complexes. The presenting ECG pattern was misinterpreted as ventricular tachycardia (VT) with resultant delayed emergency percutaneous coronary intervention. The patient died of intractable cardiogenic shock. This case corroborates previous research findings associating the ECG pattern comprising "triangular" or "lambda-like" QRS-ST-T complexes observed in the clinical setting of acute myocardial ischemia with acute LMCA occlusion. Also, we demonstrate how this ECG pattern should be scrutinized for ST-segment elevation in order to avoid misdiagnosing a STEMI for VT.
Collapse
Affiliation(s)
- Andreas Y Andreou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus.
| | | | - Lida Efstathia Koskina
- University of Nicosia Medical School, Nicosia, Cyprus; St George's University of London MBBS Programme, University of Nicosia Medical School, Nicosia, Cyprus
| |
Collapse
|
8
|
Verdoia M, Viola O, Marrara F, Soldà PL. A 'shark'-masked electrocardiogram: case report of a Tako-Tsubo syndrome. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab132. [PMID: 34124561 PMCID: PMC8189302 DOI: 10.1093/ehjcr/ytab132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/21/2020] [Accepted: 02/23/2021] [Indexed: 12/25/2022]
Abstract
Background Triangular ST-segment elevation or 'shark-fin' sign has been described as a specific indicator of acute coronary occlusion and large myocardial ischaemia, translating into poorer prognosis. However, this electrocardiographic presentation has been reported in rare cases of Tako-Tsubo syndrome and associated with more severe physical stressors and neurological involvement. Case summary We present a rare case of a 51-year-old woman presenting with incoming epileptic attacks and concomitant pyometra. Despite controlling epilepsy with phenytoin and the surgical treatment of the infection, she developed sepsis requiring vasopressors, and thereafter sustained ventricular tachycardia and diffuse ST-segment elevation with the 'shark-fin' sign. TTC was confirmed by the documentation of normal coronary arteries and the complete recovery of wall motion abnormalities at discharge. Discussion Heterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.
Collapse
Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, 13900 Biella, Italy
| | - Orazio Viola
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, 13900 Biella, Italy
| | - Federica Marrara
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, 13900 Biella, Italy
| | - Pier Luigi Soldà
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, 13900 Biella, Italy
| |
Collapse
|