The J wave during ST-segment elevation myocardial infarction and its implications

Excerpt

A 51-year-old male nurse who was diabetic and hypertensive experienced in-hospital chest pain and a witnessed cardiac arrest. Cardiopulmonary resuscitation (CPR) was provided for 20 min during which he was defibrillated twice for ventricular fibrillation (V-fib). An electrocardiogram (ECG) following restoration of spontaneous circulation revealed ST-segment elevation (STE) in leads II, III, aVF, V₁, V₂, V₆, V₃R, and V₄R, conforming to an acute inferior and right ventricular ST-segment elevation myocardial infarction (STEMI) and thrombolytic therapy was administered (Fig. 1 a). Additionally, there were evident J waves in leads V₃ to V₅ (arrows). STE in the inferior leads resolved 15 min later, with the appearance of J waves in those leads (Fig. 1 b). An ECG 2 h after thrombolytic therapy revealed resolution of STE with disappearance of J waves from V₃ to V₅ and marked reduction in amplitude of the J waves in the inferior leads (Fig. 1 c). The case was complicated by cardiogenic shock and death resulting from severe right ventricular failure resistant to fluid infusion and to inotropic and vasopressor support. …