Electrocardiographic T-wave changes underlying acute cardiac and cerebral events.

T-wave inversions produced by myocardial infarction (MI) are classically narrow and symmetric. Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology. We present a series of cases that presented with different electrocardiography T-wave changes. The first case involved a 64-year-old woman who presented to the emergency department with diffuse splayed T-wave inversions and was found to have an MI in the context of an acute cerebrovascular accident. We contrasted this case with that of a 76-year-old man with hypercholesterolemia who presented with T-wave widening and a prolonged QT interval and was found to have a subarachnoid hemorrhage secondary to a basilar aneurysm and no MI. Several mechanisms have been suggested to explain the cardiac and cerebral injury, including microvascular spasm and increased levels of circulating catecholamines. Accurate interpretation of T-wave changes can assist the clinician toward a timely therapeutic intervention and accurate diagnosis.

Primary angioplasty in a patient with dextrocardia.

Dextrocardia is a rare anomaly affecting 0.01% of newborns. We report on a case of a 60-year-old female with mirror-image dextrocardia who presented with an acute myocardial infarction and underwent primary angioplasty of the left circumflex artery. A review of the literature and technical challenges of the case will be addressed.