July 2021 Issue
ISSN 2689-291X
ISSN 2689-291X
Shark Fin Sign..
An Electrocardiographic Sign of Massive Infarction!
Description
The shark fin sign has been described as indicative of massive myocardial infarction, involving the left anterior descending (LAD) or the left main (LM) coronary arteries. Jaiswal and Shah [1] reported a 48 year old patient with chest pain and a shark fin EKG who has a proximal LAD occlusion requiring intervention. Miranda et al [2] reported transient triangular QRS-ST-T wave form consistent with shark fin pattern in a 54 year old patient who was found to have subtotaled LM on coronary angiography. Janaki Rami Reddy and Garg [3] reported shark fin sign on an EKG of a 75 year old patient who was found to have diffuse LAD and right coronary artery (RCA) spasms, which resolved with intracoronary nitroglycerin with residual mild to moderate coronary obstruction; this was attributed to blood-containing pericardial effusion caused by underlying pericarditis. Verdoia et al. [4] reported a shark fin sign on the EKG of a 51 year old female patient being treated for sepsis who developed ventricular tachycardia and apical ballooning on echocardiography; but with minimal coronary disease; indicative of Takotsubo cardiomyopathy. EKG and echocardiographic changes resolved slowly over few days with conservative management. Madias [5] described giant R waves, reminiscent of the shark fin sign, as a pattern seen early in the course of an acute myocardial infarction. Takahashi et at. [6] reported lambda waves on EKG, a shark fin pattern, during tachycardia in an 80-year-old male with angina, who was found to have severe proximal LAD disease successfully treated with a drug eluting stent guided by intravascular ultrasound (IVUS).
References:
Authors:
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Alexis Parks, D.O.
Internal Medicine Resident
University of South Alabama
Mobile, AL
Siva Chiranjeevi, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O
Assistant Professor
University of South Alabama
Mobile, AL
Amod Amritphale, M.D.
Assistant Professor
University of South Alabama
Mobile, AL
G. Mustafa Awan, M.D.
Associate Professor
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL
The shark fin sign has been described as indicative of massive myocardial infarction, involving the left anterior descending (LAD) or the left main (LM) coronary arteries. Jaiswal and Shah [1] reported a 48 year old patient with chest pain and a shark fin EKG who has a proximal LAD occlusion requiring intervention. Miranda et al [2] reported transient triangular QRS-ST-T wave form consistent with shark fin pattern in a 54 year old patient who was found to have subtotaled LM on coronary angiography. Janaki Rami Reddy and Garg [3] reported shark fin sign on an EKG of a 75 year old patient who was found to have diffuse LAD and right coronary artery (RCA) spasms, which resolved with intracoronary nitroglycerin with residual mild to moderate coronary obstruction; this was attributed to blood-containing pericardial effusion caused by underlying pericarditis. Verdoia et al. [4] reported a shark fin sign on the EKG of a 51 year old female patient being treated for sepsis who developed ventricular tachycardia and apical ballooning on echocardiography; but with minimal coronary disease; indicative of Takotsubo cardiomyopathy. EKG and echocardiographic changes resolved slowly over few days with conservative management. Madias [5] described giant R waves, reminiscent of the shark fin sign, as a pattern seen early in the course of an acute myocardial infarction. Takahashi et at. [6] reported lambda waves on EKG, a shark fin pattern, during tachycardia in an 80-year-old male with angina, who was found to have severe proximal LAD disease successfully treated with a drug eluting stent guided by intravascular ultrasound (IVUS).
References:
- Jaiswal AK, Shah S. Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in ST-Elevation Myocardial Infarction (STEMI). Cureus. 2021 Jun 28;13(6):e15989.
- Miranda JM, de Oliveira WS, de Sá VP, de Sá IF, Neto NO. Transient triangular QRS-ST-T waveform with good outcome in a patient with left main coronary artery stenosis: A case report. J Electrocardiol. 2019 May-Jun;54:87-89.
- Janaki Rami Reddy M, Garg J. Shark fin sign. J Arrhythm. 2021 Jul 14;37(5):1362-1363.
- Verdoia M, Viola O, Marrara F, Soldà PL. A 'shark'-masked electrocardiogram: case report of a Tako-Tsubo syndrome. Eur Heart J Case Rep. 2021 May 7;5(5):ytab132.
- Madias JE. The "giant R waves" ECG pattern of hyperacute phase of myocardial infarction. A case report. J Electrocardiol. 1993 Jan;26(1):77-82.
- Takahashi K, Sakaue T, Yamashita M, Enomoto D, Uemura S, Okura T, Ikeda S, Yamamura N, Ikeda K. Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves. Intern Med. 2021;60(9):1409-1415.
Authors:
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Alexis Parks, D.O.
Internal Medicine Resident
University of South Alabama
Mobile, AL
Siva Chiranjeevi, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O
Assistant Professor
University of South Alabama
Mobile, AL
Amod Amritphale, M.D.
Assistant Professor
University of South Alabama
Mobile, AL
G. Mustafa Awan, M.D.
Associate Professor
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL