The electrocardiographic ‘triangular QRS-ST-T waveform’ pattern: a marker of severe haemodynamic compromise in Takotsubo syndrome—a case report

Background Takotsubo cardiomyopathy is characterized by transient regional systolic dysfunction of the left ventricle, mimicking myocardial infarction. Although systolic left ventricular (LV) function normalizes in most cases, the outcome is not always favourable. Recently, a rare electrocardiogram (ECG) finding, lambda wave ST elevation or ‘triangular QRS-ST-T waveform’, was suggested as a possible marker of poor outcome in Takotsubo patients Case summary After a brief episode of chest pain and shortness of breath, a 67-year-old woman developed cardiogenic shock. Her resting ECG showed widespread ST elevations, which soon evolved into a pattern of triangular QRS-ST-T waveforms in the inferior leads and V3–V6. Emergent coronary angiography was normal. The ejection fraction was 20% with apical ballooning and an LV thrombus. At 1-month follow-up, the patient was asymptomatic and the ECG showed only T-wave inversions. Discussion The triangular QRS-ST-T waveform ECG pattern has recently been introduced as a high-risk marker in the Takotsubo syndrome.

Motivic Wave Front Sets

The concept of wave front set was introduced in 1969–1970 by Sato in the hyperfunctions context [1, 34] and by Hörmander [23] in the $\mathcal C^{\infty }$ context. Howe in [25] used the theory of wave front sets in the study of Lie groups representations. Heifetz in [22] defined a notion of wave front set for distributions in the $p$-adic setting and used it to study some representations of $p$-adic Lie groups. In this article, we work in the $k\mathopen{(\!(} t \mathopen{)\!)}$-setting with $k$ a Characteristic 0 field. In that setting, balls are no longer compact but working in a definable context provides good substitutes for finiteness and compactness properties. We develop a notion of definable distributions in the framework of [13] and [14] for which we define notions of singular support and $\Lambda$-wave front sets (relative to some multiplicative subgroups $\Lambda$ of the valued field) and we investigate their behavior under natural operations like pullback, tensor product, and products of distributions.