Macroscopic T-wave alternans in a patient presenting with hepatic encephalopathy.

Macroscopic T-wave alternans (TWA) is the beat-to-beat variation in the amplitude or shape of the T wave on a surface electrocardiogram (ECG) and known to be a harbinger of impending malignant ventricular arrhythmias such as polymorphic ventricular tachycardia. We herein report a case with hepatic encephalopathy, who developed TWA, followed by polymorphic ventricular tachycardia.

Is the spiked helmet sign the manifestation of long QT syndrome?

We present the case of a patient with Takotsubo syndrome developing simultaneous inferior, anterior spiked helmet sign (SHS) and macroscopic T-wave alternans (TWA) leading to torsade de pointes ventricular tachycardia (TdP VT). Based on our observations we propose that the SHS is a type of manifestation of critically prolonged QT(U).