“Lambda‐wave” ST‐elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy

Abstract

Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.

Triangular QRS-ST-T Waveform Electrocardiographic Pattern in Acute Myopericarditis: A Case Report from a Limited-Resources Hospital

“…Other than in ischemic conditions, TW pattern can also present in non-ischemic conditions, such as in takotsubo cardiomyopathy. In takotsubo cardiomyopathy, the presence of TW is associated with higher risk of complications at short-term and long-term follow-up [ 9 ]. To the best of our knowledge, this is the first report of TW ECG pattern in a patient with acute myopericarditis.…”

The non‐acute coronary syndrome related ST‐elevation patterns (NASTEP) conundrum: War helmets, Greek letters, and… “shark fins”

“…We greatly appreciated the interest shown by Madias regarding our article "Lambda-wave ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy" published on this journal (Tarantino et al, 2018).…”

“…Unfortunately, pre-TTS electrocardiograms can be compared in only two patients [one already reported in Figure 4b (Tarantino et al, 2018), and a transient TTS-related reduction of QRS amplitude was notable. Moreover, two patients out of five deceased during in-hospital stay, therefore no electrocardiogram could be Reply to "Other correlates of "lambda wave" in patients with takotsubo syndrome?…”

Other correlates of “lambda wave” in patients with takotsubo syndrome?

“…(f) since the authors are referring to the stellate ganglia activation, in the future monitoring of the sympathetic autonomic input to the heart, using ECG based technology (Madias, 2017), may be of value; (g) since the amplitude of QRS complexes of the two patients depicted in fig. 4 of the paper (Tarantino et al, 2018) show some changes over the course of hospitalization, and the one in fig. 4b shows low-amplitude in both limb and precordial leads, it would be of interest to compare the ECGs in these five patients, recorded in the hospital with the ones prior to admission and the ones recorded at post-discharge follow-up, in regard to transient low-amplitude QRS complexes in connection with TTS, attributed to myocardial edema (Madias, 2014).…”

“…Dear Editor, I read with great interest the report by Tarantino et al (2018), about the correlates of electrocardiogram (ECG) "lambda wave" (LW) in five patients out of 158 patients admitted with takotsubo syndrome (TTS); peak ST-segment elevation (+ST) of LW was reached by 6 hr, after admission, with a peak between 6 and 12 hr, and gradual decrease by 24 hr, and was associated with higher prevalence of physical stressors, admission and peak levels of troponin I levels, and in-hospital adverse events, with one patient developing endoventricular thrombosis, and two dying with cardiogenic shock, and higher long-term follow-up adverse events compared to the remaining 153 patients (Tarantino et al, 2018). I have a few comments/ questions for the kind consideration of the authors: (a) did the LW patients present to the hospital earlier than the rest?…”