The negative U wave in the setting of demand ischemia

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The negative U wave in the setting of demand ischemia

To the Editor: We thank Drs. Venkatachalam and Rimmerman1 for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.

References
  1. Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: It’s in the details. Cleve Clin J Med 2011; 78:505506.
  2. Sovari AA, Farokhi F, Kocheril AG. Inverted U wave, a specific electrocardiographic sign of cardiac ischemia. Am J Emerg Med 2007; 25:235237.
  3. Correale E, Battista R, Ricciardiello V, Martone A. The negative U wave: a pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease. Clin Cardiol 2004; 27:674677.
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Promporn Suksaranjit, MD
Bassett Medical Center, Cooperstown, NY

Wisit Chenungpasitporn, MD
Bassett Medical Center, Cooperstown, NY

Edward F. Bischof, MD
Bassett Medical Center, Cooperstown, NY

Herbert Marx, MD
Bassett Medical Center, Cooperstown, NY

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Promporn Suksaranjit, MD
Bassett Medical Center, Cooperstown, NY

Wisit Chenungpasitporn, MD
Bassett Medical Center, Cooperstown, NY

Edward F. Bischof, MD
Bassett Medical Center, Cooperstown, NY

Herbert Marx, MD
Bassett Medical Center, Cooperstown, NY

Author and Disclosure Information

Promporn Suksaranjit, MD
Bassett Medical Center, Cooperstown, NY

Wisit Chenungpasitporn, MD
Bassett Medical Center, Cooperstown, NY

Edward F. Bischof, MD
Bassett Medical Center, Cooperstown, NY

Herbert Marx, MD
Bassett Medical Center, Cooperstown, NY

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To the Editor: We thank Drs. Venkatachalam and Rimmerman1 for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.

To the Editor: We thank Drs. Venkatachalam and Rimmerman1 for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.

References
  1. Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: It’s in the details. Cleve Clin J Med 2011; 78:505506.
  2. Sovari AA, Farokhi F, Kocheril AG. Inverted U wave, a specific electrocardiographic sign of cardiac ischemia. Am J Emerg Med 2007; 25:235237.
  3. Correale E, Battista R, Ricciardiello V, Martone A. The negative U wave: a pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease. Clin Cardiol 2004; 27:674677.
References
  1. Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: It’s in the details. Cleve Clin J Med 2011; 78:505506.
  2. Sovari AA, Farokhi F, Kocheril AG. Inverted U wave, a specific electrocardiographic sign of cardiac ischemia. Am J Emerg Med 2007; 25:235237.
  3. Correale E, Battista R, Ricciardiello V, Martone A. The negative U wave: a pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease. Clin Cardiol 2004; 27:674677.
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