Macroscopic T Wave Alternans in a Patient with Rheumatic Heart Disease

Abstract

A middle-aged lady in her late forties and a known case of rheumatic heart disease presented with acute decompensated heart failure. On admission, she was found to have atrial fibrillation with fast ventricular rate. She was initially managed with mechanical ventilation, diuretics, and parenteral amiodarone. During admission, she had two episodes of ventricular tachycardia at 12 h interval for which she was electro-cardioverted. Post-cardioversion, she developed giant and deep T waves with macroscopic T wave alternans which is a harbinger of further malignant arrhythmias. She was managed conservatively, and she responded well to the treatment. We intend to present this rare electrocardiographic repolarization abnormality and its reversal to normal T waves and QT interval as the patient improved.

Keywords

• electro-cardioversion
• giant t waves
• macroscopic t wave alternans
• myocarditis