Deutsche medizinische Wochenschrift (1946) · 2012
[Upright T-wave in V1 as predictor of significant coronary artery disease].
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Högemann A, Nordmeyer P
Аннотация
HISTORY AND CLINICAL FINDINGS: The 56-year-old man came to our emergency department because of heartburn, chest tightness and sweating. Cardiovascular risk factors were obesity and hypertension. Clinical examination revealed no significant abnormalities.
EXAMINATIONS: Laboratory results showed no pathologies except a slightly elevated creatinine (1,19 ng/dl). Troponin I ultra sensitive was negative (< 0,006 ng/ml), CK and CK-MB not elevated. The 12-channel-ECG revealed sinus rhythm with a heart rate of 68/min, a non-significant ST-elevation in V2 as well as elevated T-waves in V1 and V2. The T-wave in V1 was positive (> 0,15 mV) and bigger than the T-wave in V6.
TREATMENT AND COURSE: The patient was monitored at our intermediate-care ward. The troponin level was checked again after about four hours and showed a troponin of 1,519 ng/ml (norm: 0,02 - 0,06 ng/ml). NSTEMI was diagnosed and coronary angiography was performed next morning, demonstrating coronary three vessel disease with 95 % occlusion of the left anterior descending (LAD).
CONCLUSION: An upright T-wave in V1 can be an indicator for coronary artery disease (CAD). A bigger T-wave in V1 than in V6 can indicate CAD with LAD involvement. Therefore, in patients with thoracic pain and a positive T-wave in V1 cardiac ischemia should be considered.
EXAMINATIONS: Laboratory results showed no pathologies except a slightly elevated creatinine (1,19 ng/dl). Troponin I ultra sensitive was negative (< 0,006 ng/ml), CK and CK-MB not elevated. The 12-channel-ECG revealed sinus rhythm with a heart rate of 68/min, a non-significant ST-elevation in V2 as well as elevated T-waves in V1 and V2. The T-wave in V1 was positive (> 0,15 mV) and bigger than the T-wave in V6.
TREATMENT AND COURSE: The patient was monitored at our intermediate-care ward. The troponin level was checked again after about four hours and showed a troponin of 1,519 ng/ml (norm: 0,02 - 0,06 ng/ml). NSTEMI was diagnosed and coronary angiography was performed next morning, demonstrating coronary three vessel disease with 95 % occlusion of the left anterior descending (LAD).
CONCLUSION: An upright T-wave in V1 can be an indicator for coronary artery disease (CAD). A bigger T-wave in V1 than in V6 can indicate CAD with LAD involvement. Therefore, in patients with thoracic pain and a positive T-wave in V1 cardiac ischemia should be considered.