Abstract
Background: The differential diagnosis of ST elevation is broad, including ischemia, hyperkalemia, benign repolarization, and others. Here we present a case of ST elevations immediately post cardiac shock wave therapy, a non-invasive modality based on the lithotripsy method using low-intensity shock waves to stimulate angiogenesis, reduce angina, and improve myocardial perfusion. Case: 84-year-old male with a history of coronary artery disease, type 2 diabetes mellitus, hypertension, was admitted to the hospital with unstable angina. He received laser atherectomy, cardiac shock wave therapy, as well as a drug eluting stent to the mid left anterior descending artery. Patient was brought to the coronary care unit (CCU) for post-catheterization monitoring and was immediately noted to have prominent ST elevations in leads V2-V6 (Fig 1), however remained stable and asymptomatic. Bedside echocardiogram showed no new segmental wall motion abnormalities or pericardial effusion. He was taken back to the catheterization lab for a second look revealing the newly placed patent stents. Serial EKGs in the CCU showed resolving ST elevations, without the formation of new q waves, and he was discharged the next morning. Discussion: Shock wave therapy was introduced in 1980 as a treatment for ureteral stones. Now, shock wave therapy is delivered to areas of ischemic myocardium to stimulate angiogenesis and reduce refractory anginal symptoms. Electrocardiographic changes after shock wave therapy have not been studied and more importantly, their clinical implications remain unclear. New ST elevations after revascularization is often an ominous sign, indicating continuing ischemia or aneurysm. We postulate that in the setting of cardiac shock wave therapy, ST elevations may represent stunned myocardium as a consequence of the high-voltage discharges. Further studies and case reports are needed to evaluate the clinical implications of ST elevations after shock wave therapy
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