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In Reply: We appreciate the comments from Drs. Suksaranjit, Cheungpasitporn, Bischof, and Marx on our recent article on the negative U wave in a patient with chronic aortic regurgitation.1 The clinical data including electrocardiography, echocardiography, and coronary angiography were presented to emphasize the importance of identifying the negative U wave in the setting of valvular heart disease. We outlined the common differential diagnosis for a negative U wave (page 506). We believe that in the appropriate clinical setting the presence of a negative U wave provides diagnostic utility.
Several published reports to date have described the occurrence of the negative U wave in the setting of obstructive coronary artery disease2–5 or coronary artery vasospasm.6 We were unable to find similar data in the setting of demand ischemia in the presence of normal coronary arteries (functional ischemia), but we fully recognize its likely occurrence, and we value the helpful insight.
- Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: it’s in the details. Cleve Clin J Med 2011; 78:505–506.
- Gerson MC, Phillips JF, Morris SN, McHenry PL. Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery. Circulation 1979; 60:1014–1020.
- Galli M, Temporelli P. Images in clinical medicine. Negative U waves as an indicator of stress-induced myocardial ischemia. N Engl J Med 1994; 330:1791.
- Miwa K, Nakagawa K, Hirai T, Inoue H. Exercise-induced U-wave alterations as a marker of well-developed and well-functioning collateral vessels in patients with effort angina. J Am Coll Cardiol 2000; 35:757–763.
- Rimmerman CM. A 62-year-old man with an abnormal electrocardiogram. Cleve Clin J Med 2001; 68:975–976.
- Kodama-Takahashi K, Ohshima K, Yamamoto K, et al. Occurrence of transient U-wave inversion during vasospastic anginal attack is not related to the direction of concurrent ST-segment shift. Chest 2002; 122:535–541.
In Reply: We appreciate the comments from Drs. Suksaranjit, Cheungpasitporn, Bischof, and Marx on our recent article on the negative U wave in a patient with chronic aortic regurgitation.1 The clinical data including electrocardiography, echocardiography, and coronary angiography were presented to emphasize the importance of identifying the negative U wave in the setting of valvular heart disease. We outlined the common differential diagnosis for a negative U wave (page 506). We believe that in the appropriate clinical setting the presence of a negative U wave provides diagnostic utility.
Several published reports to date have described the occurrence of the negative U wave in the setting of obstructive coronary artery disease2–5 or coronary artery vasospasm.6 We were unable to find similar data in the setting of demand ischemia in the presence of normal coronary arteries (functional ischemia), but we fully recognize its likely occurrence, and we value the helpful insight.
In Reply: We appreciate the comments from Drs. Suksaranjit, Cheungpasitporn, Bischof, and Marx on our recent article on the negative U wave in a patient with chronic aortic regurgitation.1 The clinical data including electrocardiography, echocardiography, and coronary angiography were presented to emphasize the importance of identifying the negative U wave in the setting of valvular heart disease. We outlined the common differential diagnosis for a negative U wave (page 506). We believe that in the appropriate clinical setting the presence of a negative U wave provides diagnostic utility.
Several published reports to date have described the occurrence of the negative U wave in the setting of obstructive coronary artery disease2–5 or coronary artery vasospasm.6 We were unable to find similar data in the setting of demand ischemia in the presence of normal coronary arteries (functional ischemia), but we fully recognize its likely occurrence, and we value the helpful insight.
- Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: it’s in the details. Cleve Clin J Med 2011; 78:505–506.
- Gerson MC, Phillips JF, Morris SN, McHenry PL. Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery. Circulation 1979; 60:1014–1020.
- Galli M, Temporelli P. Images in clinical medicine. Negative U waves as an indicator of stress-induced myocardial ischemia. N Engl J Med 1994; 330:1791.
- Miwa K, Nakagawa K, Hirai T, Inoue H. Exercise-induced U-wave alterations as a marker of well-developed and well-functioning collateral vessels in patients with effort angina. J Am Coll Cardiol 2000; 35:757–763.
- Rimmerman CM. A 62-year-old man with an abnormal electrocardiogram. Cleve Clin J Med 2001; 68:975–976.
- Kodama-Takahashi K, Ohshima K, Yamamoto K, et al. Occurrence of transient U-wave inversion during vasospastic anginal attack is not related to the direction of concurrent ST-segment shift. Chest 2002; 122:535–541.
- Venkatachalam S, Rimmerman CM. Electrocardiography in aortic regurgitation: it’s in the details. Cleve Clin J Med 2011; 78:505–506.
- Gerson MC, Phillips JF, Morris SN, McHenry PL. Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery. Circulation 1979; 60:1014–1020.
- Galli M, Temporelli P. Images in clinical medicine. Negative U waves as an indicator of stress-induced myocardial ischemia. N Engl J Med 1994; 330:1791.
- Miwa K, Nakagawa K, Hirai T, Inoue H. Exercise-induced U-wave alterations as a marker of well-developed and well-functioning collateral vessels in patients with effort angina. J Am Coll Cardiol 2000; 35:757–763.
- Rimmerman CM. A 62-year-old man with an abnormal electrocardiogram. Cleve Clin J Med 2001; 68:975–976.
- Kodama-Takahashi K, Ohshima K, Yamamoto K, et al. Occurrence of transient U-wave inversion during vasospastic anginal attack is not related to the direction of concurrent ST-segment shift. Chest 2002; 122:535–541.