Patients with amyotrophic lateral sclerosis can display cardiac parasympathetic and sympathetic alterations with relative sympathetic predominance predisposing hypertensive crisis, sudden cardiac death, and cardiovascular collapse, leading to a decrease in life expectancy.
- Pavlovic S.
- Stevic Z.
- Milovanovic B.
- et al.
Impairment of cardiac autonomic control in patients with amyotrophic lateral sclerosis.
Furthermore, amyotrophic lateral sclerosis can produce QT-segment prolongation, leading to an increased risk for sudden cardiac death, apparently due to loss of the intermediolateral nucleus of the upper thoracic spinal cord.
- Asai H.
- Hirano M.
- Udaka F.
- et al.
Sympathetic disturbances increase risk of sudden cardiac arrest in sporadic ALS.
In addition to all these pathophysiological findings seen in these patients, in recent years there have been reports of electrocardiographic abnormalities resembling acute myocardial infarctions. As described by Li et al,
- Li A.H.
- Hsu K.L.
- Liau C.S.
- et al.
Amyotrophic lateral sclerosis with a ‘pseudo-infarction’ pattern on the electrocardiograph. A case report.
a patient presented with an ST elevation and biphasic T waves in the precordial leads in the setting of normal cardiac studies. Similarly, Zhang et al
- Zhang J.
- Yang S.W.
- Wang Z.
- et al.
Pseudo-ischaemic ECG in a patient with amyotrophic lateral sclerosis surviving for a decade.
described a patient who presented with T-wave inversions in all leads, resembling an ischemic event. To date, there is no clear involved mechanism that explains these ECG manifestations; nevertheless, these disturbances in the autonomic function in this patient population are possibly due to a degenerative process, leading to anatomical and metabolic disarrangements.
Moreover, these cardiovascular abnormalities also can be precipitated by chronic myocardial hypoxia, leading to apoptosis or necrosis and cell release of troponin, as recently described in a patient with amyotrophic lateral sclerosis with normal coronary angiogram.
- Von Lueder T.G.
- Melsom M.N.
- Atar D.
- Agewall S.
Amyotrophic lateral sclerosis, a novel rare cause of elevated plasma troponin T levels.
Thus, we present a case of a patient with Q waves in the inferior leads on ECG with normal anatomy. We can conclude that disarrangements of the autonomic nervous system lead to pseudo-infarct patterns on ECG in patients with amyotrophic lateral sclerosis.