Mert İlker Hayiroğlu, Tufan Çınar, Vedat Çiçek, Selami Doğan, Ahmet Lütfullah Orhan

Sultan Abdülhamid Han Training and Research Hospital, Clinic of Cardiology, Istanbul, Turkey

Keywords: Ischemia; electrocardiography; R wave enhancement; inferior leads


R wave enhancement is one of the important markers of ischemia in patients with coronary artery disease. It is usually difficult to detect all stages of transmural ischemia without myocardial infarction. Here, we described a patient exhibiting R wave enhancement in his electrocardiogram (ECG) during exercise stress test. R wave enhancement is an ECG pattern of exercise test associated with the hyperacute phase of transmural ischemia. A 42-year-old smoker male patient with a complaint of chest pain for 6 months was admitted to the outpatient clinic for further evaluation. An exercise stress test was performed for ten minutes with the Bruce protocol, and the heart rate reached 162 beats/min. We observed an R wave enhancement in leads II, III and aVF accompanied by ST segment elevation in the same leads. Moreover, reciprocal ST segment depression concurrently occurred. In the recovery period, the ischemic ECG findings reversed in the same order. In the absence of Q wave, it is very rare to observe the R wave enhancement followed by ST segment elevation. Our case report illustrates the nonspecific response of the myocardium to the triggered transmural ischemia.

Cite this article as: Hayiroğlu Mİ, Çınar T, Çiçek V, Doğan S, Orhan AL. The plasticity of r wave amplitude due to transmural ischemia triggered by exercise stress test. Koşuyolu Heart J 2020;23(3):215-9.