Negative U Waves in Left Circumflex Artery Disease

Report:

Atrial rhythm 47/min

Nonspecific T wave changes & small voltage in frontal leads

Negative U waves consistent with coronary artery disease

Comment:

To tell the truth, the initial report stated “consistent with LAD artery disease” but I heard before I finished reporting the day’s ECGs that the patient had his proximal left circumflex artery stented for 90% stenosis. So I amended the record before it went into print. At least I learned something new.

The LAA cannot be reported with ectopic (or paced) atrial rhythms; it’s valid only for sinus rhythm. Atrial rhythm is one of the few causes of inverted P waves in lead 1.

This patient’s U waves persisted over 3 hours (Fig 108a) but resolved after the stenting. Fig 108a. three hours later. Sinus rhythm and much higher voltage (for unknown reason) in the frontal leads. Inverted U waves are still present in V4-6.

109. 64 year old man with history of myocardial infarction five months previously and progressive left venticular failure since, admitted for surgery. What surgery?

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Ischaemia

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