Paroxysmal Tachycardia Followed by Temporary Inversion of the T Waves.

It is now generally recognized that inversion of T waves such as is met with in coronary disease can occur in a number of other conditions also, for example, in myocardial disease due to toxaemia or hypertension, from large doses of digitalis, from the physiological effects of taking cold drinks, as a result of the position of the heart, and even from changes of posture especially in persons of the neuro-circulatory asthenic type. Attention has, however, only recently been given in the literature to the fact that electrocardiographic features simulating serious coronary disease may in certain cases occur as a transient feature after paroxysmal tachycardia. The condition, furthermore, is of more than mere academic importance, since if not recognized, an erroneous diagnosis of coronary disease may easily be made especially if the attack of paroxysmal tachycardia passes unnoticed or is thought to have been an acute coronary lesion. Either these changes after paroxysmal tachycardia are very rare or it would seem possible that cardiologists have been familiar with their occurrence but have not recorded them. White et al. (1941) in a review of various conditions other than organic disease causing inversion of the T Wvave in lead II makes no mention of paroxysmal tachycardia, and in a search of British and American papers only eighteen previous cases appear to have been described. Graybiel and White (1934) reported two cases of paroxysmal ventricular tachycardia in young robust adults, one followed by inverted T I and the other by inverted T II and T III; there was no sign of organic disease, and there was a gradual return to a normal cardiogram. Campbell and Elliott (1939) described two cases of paroxysmal tachycardia, one being ventricular, that gave transient changes simulating coronary thrombosis: one of these gave a history of diphtheria, and the other was of long standing and had been suffering from increasing dyspncea during the intervals between attacks; both died at a later date. Though these two cases differ in their organic nature from the other cases described and from the present one, which except for the electrocardiographic abnormality seemed normal in: other respects, Campbell and Elliott nevertheless laid stress on the transient nature of the cardiographic changes following the tachycardia. Cossio, Sabathie, and Berconsky (1941) described four cases, and Campbell (1942) a further three cases that were clinically benign. Currie (1942) described a further case probably of ventricular origin in a girl aged thirteen, followed by inversion ofT waves, and a return to a normal cardiogram in one month. Dubbs and Parmet (1942) added a further case, Geiger (1943) one case, Zimmerman (1944) three cases, and Ward (1946) one case. The present case was one of paroxysmal auricular tachycardia and was clinically benign.