Mansour Abdallah M, Abdullah Obai, Allaham Haytham, Danila Cristina, Balla Sudarshan
Department of Internal Medicine, University of Missouri - Columbia, Columbia, USA.
Department of Internal Medicine, University of Missouri-Columbia, Columbia, USA.
Cureus. 2018 Oct 8;10(10):e3423. doi: 10.7759/cureus.3423.
Giant negative T-waves have been linked to several cardiac and non-cardiac conditions. However, the presence of giant negative T-waves with QT prolongation in the setting of non-cardiogenic pulmonary edema is a rarely reported, female predominant, and poorly understood electrocardiographic phenomenon. We report a case of a 28-year-old white female who presented with acute diarrhea and was admitted due to acute kidney injury caused by a hemolytic uremic syndrome (HUS). She was managed with multiple blood product transfusions, plasma exchange, and hemodialysis. Subsequently, she developed acute pulmonary edema requiring intubation and urgent hemodialysis. During this acute event, a unique electrocardiographic finding of anterolateral giant negative T-wave and QT prolongation progressively developed and began resolving with the resolution of the pulmonary edema. In addition to our case, 12 cases were reported upon review of the literature with similar electrocardiography (ECG) findings in the setting of non-cardiogenic, non-ischemic pulmonary edema. Giant negative T-waves can be associated with non-cardiac pulmonary edema. Recognition of this rare Wellen's-like electrocardiographic pattern in a patient without cardiac ischemia is crucial, especially in young females. Basic science and clinicopathological correlation studies are needed to understand the pathophysiology and prognosis behind these ECG findings.
巨大倒置T波与多种心脏和非心脏疾病有关。然而，在非心源性肺水肿情况下出现巨大倒置T波伴QT间期延长是一种罕见报道、以女性为主且了解甚少的心电图现象。我们报告一例28岁白人女性病例，该患者因急性腹泻就诊，因溶血性尿毒症综合征（HUS）导致急性肾损伤而入院。她接受了多次血液制品输注、血浆置换和血液透析治疗。随后，她出现急性肺水肿，需要插管和紧急血液透析。在这一急性事件期间，前侧壁巨大倒置T波和QT间期延长这一独特的心电图表现逐渐出现，并随着肺水肿的消退而开始缓解。除我们的病例外，经文献回顾，在非心源性、非缺血性肺水肿情况下有12例报告有类似心电图（ECG）表现。巨大倒置T波可能与非心脏性肺水肿有关。在无心脏缺血的患者中识别这种罕见的类似Wellen's的心电图模式至关重要，尤其是在年轻女性中。需要进行基础科学和临床病理相关性研究以了解这些心电图表现背后的病理生理学和预后情况。
