A 41-year-old man presented to the emergency department due to retrosternal chest pain and dyspnea, which had aggravated on exertion. He was a nonsmoker and denied trauma or drug abuse, but he had a history of HIV infection which was treated with tenofovir, emtricitabine, and efavirenz. Physical examination was unremarkable without Kussmaul sign or prominent jugular veins. Electrocardiogram revealed ST-segment elevations and PR-interval depressions in leads I, II, aVL, V3 to V6 with reciprocal ST-segment depression and PR-interval elevation in lead aVR corresponding to injury of subepicardial myocardium and atrium. Additionally, small positive deflections in the J-point region could be detected in leads II, aVL, V5 and V6 (Figure 1A). Laboratory tests showed: leukocytosis (white blood cell count, 13.23×109/l; reference range, 4.4–11.3×109/l), elevated C-reactive protein levels (19.1 mg/l; reference range, 0–5 mg/l), and elevated N-terminal pro-B-type natriuretic peptide level (221 pg/ml; reference range, 0–150 pg/ml) without elevated troponin T (7 pg/ml; reference range, 0–14 pg/ml) or D-dimer (<0.19 mg/l; reference range, 0–0.5 mg/l). Echocardiography showed mild pericardial effusion.
J waves are a manifestation of early repolarization and are sometimes referred to as Osborn waves after their describer who studied the effect of hypothermia on the cardiac function in dogs.1 Besides hypothermia, J waves were described in other conditions such as hypercalcemia, Brugada syndrome, or early repolarization syndrome.2-4 In acute pericarditis, J waves are sometimes referred to as “stork leg sign” due to their pattern if the electrocardiogram is turned 180° whereby the QRS complex looks like a stork standing on one leg (inverted R wave) while the other leg is lifted to the stork’s body (inverted J point deflection) (Figure 1B). After initiation of ibuprofen 600 mg 3 times daily, the patient could be discharged home after 4 days with an uneventful recovery. No J waves were observed anymore on follow-up electrocardiograms 2 days after initial presentation and 1 month after discharge (Figure 1C).
Philipp Jud, MD, Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria, phone: +4331638530174, email: philipp.jud@medunigraz.at
May 8, 2020.
May 22, 2020.
June 3, 2020.
None declared.
Jud P, Verheyen N, Aliabadi A. Stork leg sign in acute pericarditis. Pol Arch Intern Med. 2020; 130: 683-684. doi:10.20452/pamw.15412
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- Osborn JJ. Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol. 1953; 175: 389-398.Crossref
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- Takagi M, Aonuma K, Sekiguchi Y, et al. The prognostic value of early repolarization (J wave) and ST-segment morphology after J wave in Brugada syndrome: Multicenter study in Japan. Heart Rhythm. 2013; 10: 533-539.Crossref
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- Bourier F, Denis A, Cheniti G, et al. Early repolarization syndrome: diagnostic and therapeutic approach. Front Cardiovasc Med. 2018; 5: 169.Crossref