Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves

Koji Takahashi; Tomoki Sakaue; Mina Yamashita; Daijiro Enomoto; Shigeki Uemura; Takafumi Okura; Shuntaro Ikeda; Nobuhisa Yamamura; Kaori Ikeda

doi:10.2169/internalmedicine.6197-20

CASE REPORTS

Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves

Koji Takahashi, Tomoki Sakaue, Mina Yamashita, Daijiro Enomoto, Shigeki Uemura, Takafumi Okura, Shuntaro Ikeda, Nobuhisa Yamamura, Kaori Ikeda

Author information

Koji Takahashi
Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
Department of Cardiology, Yawatahama City General Hospital, Japan
Tomoki Sakaue
Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
Department of Cardiology, Yawatahama City General Hospital, Japan
Mina Yamashita
Department of Cardiology, Yawatahama City General Hospital, Japan
Daijiro Enomoto
Department of Cardiology, Yawatahama City General Hospital, Japan
Shigeki Uemura
Department of Cardiology, Yawatahama City General Hospital, Japan
Takafumi Okura
Department of Cardiology, Yawatahama City General Hospital, Japan
Shuntaro Ikeda
Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
Department of Cardiology, Yawatahama City General Hospital, Japan
Nobuhisa Yamamura
Department of Clinical Pathology, Yawatahama City General Hospital, Japan
Kaori Ikeda
Department of Clinical Pathology, Yawatahama City General Hospital, Japan

Keywords: variant angina, lambda wave, transmural conduction delay, proximal left anterior descending coronary artery, left septal fascicular block, left anterior fascicular block

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 9 Pages 1409-1415

DOI https://doi.org/10.2169/internalmedicine.6197-20

Details

Abstract

In a patient with variant angina of the proximal left anterior descending coronary artery, myocardial ischemia changed the QRS-ST-T configurations without J-waves into those resembling "lambda" waves at maximal ST-segment elevation, and couplets or triplets of supraventricular extrasystole (SVE) changed the ischemia-induced "lambda" waves into QRS-ST-T configurations resembling a "tombstone" morphology or "monophasic QRS-ST complex." At the resolution phase of coronary spasm, the QRS-ST-T configurations returned to those without J-waves and were changed by SVE into "lambda" waves. Interestingly, neither ischemia- nor SVE-induced "lambda" waves or SVE-induced "tombstone" morphology or "monophasic QRS-ST complex" were complicated by ventricular tachyarrhythmia.

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