digitoxin and Chest-Pain

Inverted T waves produced by myocardial ischemia are classically narrow and symmetric. T-wave inversion (TWI) associated with an acute coronary syndrome (ACS) is morphologically characterized by an isoelectric ST segment that is usually bowed upward (ie, concave) and followed by a sharp symmetric downstroke. The terms coronary T wave and coved T wave have been used to describe these ischemic TWIs. Prominent, deeply inverted, and widely splayed T waves are more characteristic of non-ACS conditions such as juvenile T-wave patterns, left ventricular hypertrophy, acute myocarditis, Wolff-Parkinson-White syndrome, acute pulmonary embolism, cerebrovascular accident, bundle branch block, and later stages of pericarditis.

Topics: Adult; Aged; Arrhythmias, Cardiac; Bundle-Branch Block; Chest Pain; Coronary Disease; Diagnosis, Differential; Digitalis; Electrocardiography; Female; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Pulmonary Embolism; Stroke

Traditionally, ST segment depression has been associated with acute coronary syndromes; this electrocardiographic pattern may also be found in patients with nonischemic events, such as left bundle branch block (LBBB), left ventricular hypertrophy (LVH), and those with therapeutic digitalis levels. Using the ECG as an adjunct in distinguishing those patients with acute coronary syndromes from those with more "benign," nonacute causes of STSD will obviously lead to divergent treatment and management plans. The following cases illustrate the use the ECG in patients presenting with chest pain and electrocardiographic ST segment depression attributable to an ACS, LVH, LBBB, or digitalis.

Topics: Bundle-Branch Block; Chest Pain; Diagnosis, Differential; Digitalis; Electrocardiography; Emergencies; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Plants, Medicinal; Plants, Toxic

Topics: Adult; Bradycardia; Cardiotonic Agents; Chest Pain; Diagnosis, Differential; Digitoxin; Electrocardiography; Heart Block; Humans; Male; Myocardial Infarction; Poisoning; Suicide, Attempted

Topics: Angina Pectoris; Cardiovascular Diseases; Chest Pain; Digitalis; Humans; Myocardial Infarction