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Unusual U wave induced by reconstructed retrosternal esophagus.

Yamagata K, Uno K, Mori K, Seto Y - Clin Case Rep (2015)

Bottom Line: The present case shows that a broad compression of the right ventricle by the reconstructed stomach tube after esophagus cancer surgery induced an abnormal U wave.When facing an abnormal ECG, we should keep in mind of the mechanical compression to the heart as a differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, The University of Tokyo Hospital Tokyo, Japan.

ABSTRACT
The present case shows that a broad compression of the right ventricle by the reconstructed stomach tube after esophagus cancer surgery induced an abnormal U wave. When facing an abnormal ECG, we should keep in mind of the mechanical compression to the heart as a differential diagnosis.

No MeSH data available.


Related in: MedlinePlus

(A), ECG before esophagus reconstruction. (B), ECG of the first visit at our hospital. (C), Plain CT of the chest. The reconstructed stomach tube is compressing the RVOT and RV free wall. (D), Precordial leads of the 12-lead ECG at each visit. Eso, reconstructed stomach tube, SVC, superior vena cava, RVOT, right ventricular outflow tract, LVOT, left ventricular outflow tract, Ao, aorta, RV, right ventricle, RA, right atrium, LV, left ventricle.
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fig01: (A), ECG before esophagus reconstruction. (B), ECG of the first visit at our hospital. (C), Plain CT of the chest. The reconstructed stomach tube is compressing the RVOT and RV free wall. (D), Precordial leads of the 12-lead ECG at each visit. Eso, reconstructed stomach tube, SVC, superior vena cava, RVOT, right ventricular outflow tract, LVOT, left ventricular outflow tract, Ao, aorta, RV, right ventricle, RA, right atrium, LV, left ventricle.

Mentions: A 69-year-old woman was referred to our hospital due to ECG abnormality after retrosternal reconstruction surgery for esophageal cancer. ECG before the surgery showed no abnormality (Fig. 1A). At the first visit, ECG showed a prominent unusual shaped U wave in the right precordial leads (V1-V3) despite least change in other leads (Fig. 1B). Electrolyte levels were all within normal limits and no drug was prescribed. The plain chest CT demonstrated compression of not only the right ventricular outflow tract (RVOT), but also the right ventricle free wall by the reconstructed stomach tube (Fig. 1C). Transthoracic echocardiogram showed the compression of the right ventricle without any abnormal valvular disease and left ventricular wall motion. The U-wave morphology in the precordial leads changed for every visit (Fig. 1D). During the follow-up, the patient had symptomatic sinus bradycardia and a permanent pacemaker was implanted. Though the heart rate increased and the symptom improved, the U wave did not shorten (Fig. 1D). The patient has no symptoms as palpitations or syncope up to now.


Unusual U wave induced by reconstructed retrosternal esophagus.

Yamagata K, Uno K, Mori K, Seto Y - Clin Case Rep (2015)

(A), ECG before esophagus reconstruction. (B), ECG of the first visit at our hospital. (C), Plain CT of the chest. The reconstructed stomach tube is compressing the RVOT and RV free wall. (D), Precordial leads of the 12-lead ECG at each visit. Eso, reconstructed stomach tube, SVC, superior vena cava, RVOT, right ventricular outflow tract, LVOT, left ventricular outflow tract, Ao, aorta, RV, right ventricle, RA, right atrium, LV, left ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4641481&req=5

fig01: (A), ECG before esophagus reconstruction. (B), ECG of the first visit at our hospital. (C), Plain CT of the chest. The reconstructed stomach tube is compressing the RVOT and RV free wall. (D), Precordial leads of the 12-lead ECG at each visit. Eso, reconstructed stomach tube, SVC, superior vena cava, RVOT, right ventricular outflow tract, LVOT, left ventricular outflow tract, Ao, aorta, RV, right ventricle, RA, right atrium, LV, left ventricle.
Mentions: A 69-year-old woman was referred to our hospital due to ECG abnormality after retrosternal reconstruction surgery for esophageal cancer. ECG before the surgery showed no abnormality (Fig. 1A). At the first visit, ECG showed a prominent unusual shaped U wave in the right precordial leads (V1-V3) despite least change in other leads (Fig. 1B). Electrolyte levels were all within normal limits and no drug was prescribed. The plain chest CT demonstrated compression of not only the right ventricular outflow tract (RVOT), but also the right ventricle free wall by the reconstructed stomach tube (Fig. 1C). Transthoracic echocardiogram showed the compression of the right ventricle without any abnormal valvular disease and left ventricular wall motion. The U-wave morphology in the precordial leads changed for every visit (Fig. 1D). During the follow-up, the patient had symptomatic sinus bradycardia and a permanent pacemaker was implanted. Though the heart rate increased and the symptom improved, the U wave did not shorten (Fig. 1D). The patient has no symptoms as palpitations or syncope up to now.

Bottom Line: The present case shows that a broad compression of the right ventricle by the reconstructed stomach tube after esophagus cancer surgery induced an abnormal U wave.When facing an abnormal ECG, we should keep in mind of the mechanical compression to the heart as a differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, The University of Tokyo Hospital Tokyo, Japan.

ABSTRACT
The present case shows that a broad compression of the right ventricle by the reconstructed stomach tube after esophagus cancer surgery induced an abnormal U wave. When facing an abnormal ECG, we should keep in mind of the mechanical compression to the heart as a differential diagnosis.

No MeSH data available.


Related in: MedlinePlus