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

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

Intern Med. 2021;60(9):1409-1415. doi: 10.2169/internalmedicine.6197-20. Epub 2021 May 1.

Authors

Koji Takahashi^{1

2}, Tomoki Sakaue^{1

2}, Mina Yamashita², Daijiro Enomoto², Shigeki Uemura², Takafumi Okura², Shuntaro Ikeda^{1

2}, Nobuhisa Yamamura³, Kaori Ikeda³

Affiliations

¹ Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan.
² Department of Cardiology, Yawatahama City General Hospital, Japan.
³ Department of Clinical Pathology, Yawatahama City General Hospital, Japan.

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.

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

MeSH terms

Angina Pectoris, Variant* / complications
Angina Pectoris, Variant* / diagnosis
Arrhythmias, Cardiac
Electrocardiography*
Humans
Ischemia
Tachycardia