Case Report: Dynamic J-point elevation as a novel precursor to torsade de pointes: electrocardiographic markers for proactive management

Figures

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  Figure 1. Electrocardiographic (ECG) evolution and monitoring strips. (A) Continuous ECG monitoring strip from lead II upon ICU admission, showing significant J-point and ST-segment elevation (blue arrows). (B) Baseline 12-lead ECG recorded prior to symptom onset, demonstrating a normal pattern for comparison. (C) Sequential ECG strips from ICU monitor showing the progression from gradual J-point and ST-segment elevation (top) to the emergence of ventricular tachycardia (bottom). (D) The subsequent development of polymorphic ventricular tachycardia (Torsade de Pointes).

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  Figure 2. Cardiac imaging assessments. (A) Transthoracic echocardiogram (parasternal long-axis view) indicating a structurally normal heart. Quantitative measurements are displayed, including a left ventricular ejection fraction (LVEF) of 45.1%. (B) Cardiac magnetic resonance image (four-chamber view) with late gadolinium enhancement. The homogeneous myocardial signal and the scale bar (10 cm) confirm the absence of edema, fibrosis, or structural abnormalities.

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  Figure 3. Coronary angiographic findings. Multiple angiographic views of the coronary arteries. The top image shows the right coronary artery (RCA) with its branches. The bottom left image highlights the left main coronary artery and its bifurcations into the left anterior descending (LAD) and left circumflex (LCX) arteries. The bottom right image provides another detailed view of the coronary vasculature. All views demonstrate patent arteries without evidence of stenosis or occlusion.