Q: 53 year old male is admitted to ICU after he developed chest pain and shortness of breath at cardiology's office during exercise stress test. EKG during exercise testing showed "reverse/inverted U wave". Which vessel(s) be the most probable culprit?
Answer: left main or left anterior descending (LAD)
Reverse or inverted U wave during stress may be indicative either of volume overload or "tight stenosis" of the left main or left anterior descending (LAD) coronary artery.
1. Gerson MC, Phillips JF, Morris SN, McHenry PL (1979). "Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery". Circulation. 60: 1014–1020.
2. Conrath C, Opthof T (2005). "The patient U wave". Cardiovasc Res. 67 (2): 184–6.