Abstract 12815: Lambda-like St-segment Elevation in Acute Myocardial Infarction: May be a New Risk Predictor for Lethal Ventricular Arrhythmia

Abstract

Introduction: Ventricular arrhythmia (VA) is the frequent most cause of SCD in AMI patients. Among, early VT and VF are associated with high in-hospital mortality. Certain ECG changes during AMI was reported to be associated with lethal VA. We described a case of lethal VA in AMI patient with a specific ECG sign - the Lambda ST elevation. Case Description: A 49 year old diabetic and hypertensive man presented with worse ever angina. Examination showed bilateral lung crepitation. ECG revealed wide spread Lambda shaped ST elevation over anteroinferior lead with reciprocal changes. He was treated as anteroinferior STEMI and planned for PPCI. During preparation, he developed VF and resuscitated with CPR and defibrillations. He was then intubated and BP supported with inotropes. Coronary angiogram showed acute total occlusion of RCA and LAD. We decided PCI to both vessels. Multiple white thrombus aspirated from RCA and successfully established TIMI II flow. Just before deployment of the stent, he developed VF again and resuscitated. RCA was stented after ROSC. Similarly, multiple red and white thrombus aspirated from LAD. After balloon dilatation, TIMI II flow re-established with no obvious lesion. Unfortunately, he developed VF storm in between and succumbed despite one hour of resuscitation effort with acceptable angiographic results. Discussion: The presence of elevated J-wave followed by a steep downsloping elevated ST segment that merges with the inverted T wave, forming a Lambda or shark fin shape, was reported to be associated with fatal VA, cardiogenic shock and in-hospital mortality. It is closely related to early abnormal ventricular repolarization, which involves acute myocardial ischemia and genetic abnormality. Conclusion: This case demonstrated that the presence of Lambda-like ST elevation in AMI may be a risk predictor for lethal VA and cardiogenic shock. Early recognition of this high risk group and prompt aggressive treatment strategies can be lifesaving.