Paroxysmal ventricular tachycardia followed by electrocardiographic syndrome: With a report of a case

Abstract

Striking electrocardiographic alterations may persist for a long period of time after an attack of paroxysmal tachycardia in individuals who do not have evidence of structural heart disease. These changes are most prominent following paroxysms of ventricular tachycardia and consist of depression of the S-T segments, lowering or inversion of the T waves, and prolongation of the Q-T interval. This phenomenon has not been generally recognized. Graybiel and White 1 (1934) were probably the first to call attention to the fact that there may be an inversion of T waves which gradually return to normal following paroxysmal tachycardia in individuals who do not have other evidences of heart disease. Burak and Scherf 2 (1933) reported that after an attack of persistent paroxysmal tachycardia the electrocardiogram may for several hours whow negative T waves, lowered S-T segment, and alterations of the initial deflections. These electrocardiographic changes may be misinterpreted as indicative of serious heart diseases, such as coronary occlusion, coronary thrombosis, myocardial strain, cardiac damage caused by the tachycardia (anoxia, exhaustion), toxic myocarditis, and pericarditis; or the changes may be ascribed to quinidine or digitalis intoxication. The only review of this subject to date was that of Cossio, Vedoya, and Berconsky, 3 which appeared in the Argentine literature. They discussed their findings after analyzing twenty-two cases. It is the purpose of this paper to supplement their discussion, cite the three cases subsequently reported by Zimmerman, 4 and report an additional case.