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"Apical sparing" T-wave inversion in a case of mid-ventricular takotsubo syndrome.

Alessia GiannattasioAnna BaritussioMarco GallucciFederico MiglioreDomenico CorradoAlessandro Zorzi
Published in: Pacing and clinical electrophysiology : PACE (2021)
Previous studies showed that myocardial edema correlates with dynamic T-wave inversion and QTc prolongation in a variety of acute cardiovascular diseases including takotsubo syndrome (TTS). We reported the case of a patient with "atypical" (mid-ventricular) TTS showing a unique pattern of diffuse T-wave inversion that spared only the apical precordial leads V3-V4. Cardiac magnetic resonance (CMR) showed myocardial edema involving all mid-ventricular segments but not the apex. Both ECG and CMR normalized at follow-up evaluation. This case further reinforces the theory of an association between presence and regional distribution of acute myocardial inflammation and dynamic repolarization changes.
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