A Deadly Electrocardiography Shark Fin Sign in ST Elevation Myocardial Infarction: A Case Report
Abstract
Shark fin ECG pattern, also known as 'giant R waves', or 'triangular QRS-ST-T waveform' is a high-risk ECG pattern associated with ST-elevation myocardial infarction (STEMI). Shark fin ECG is typically accompanied by occlusion of the left main coronary artery and the left anterior descending artery, and it is considered to be related to a high risk of death through cardiac arrest and cardiogenic shock. Objective: This case report aims to present a case study of a patient with acute coronary syndrome st-elevation myocardial infarction with a shark fin ECG pattern. Methods: The method used is a descriptive case report design conducted on one subject. Data were collected by conducting interviews, assessments, and therapy for one patient with a shark fin ECG sign in ST-Elevation myocardial infarction. Data analysis compared the results with the theory and previous study. Results: The result of this study indicated that Mr. X aged 44 years, was in cardiac arrest and unstable hemodynamic, and experienced a return of spontaneous circulation (ROSC) after he was given 45 minutes of cardiopulmonary resuscitation (CPR), and the electrocardiography result showed shark fin sign and extensive anterior st elevation, the patient then underwent primary percutaneous intervention and the coronary catheterization showed total occlusion in left anterior descending artery (LAD), proximal stenosis 20% in the left circumflex artery (LCx), and proximal stenosis 30% in the right coronary artery (RCA). The drug-eluting stent was finally placed in the LAD. Conclusions: Shark fin sign ECG pattern indicates total occlusion and a large area of transmural ischemia, and predicts high mortality, early recognition and prompt aggressive treatment can reduce the risk of more serious complications and mortality.
References
Aizawa, Y., Jastrzebski, M., Ozawa, T., Kawecka-Jaszcz, K., Kukla, P., Mitsuma, W., Chinushi, M., Ida, T., Aizawa, Y., Ojima, K., Tagawa, M., Fujita, S., Okabe, M., Tsuchida, K., Miyakita, Y., Shimizu, H., Ito, S., Imaizumi, T., & Toba, K. (2012). Characteristics of electrocardiographic repolarization in acute myocardial infarction complicated by ventricular fibrillation. Journal of Electrocardiology, 45(3), 252–259. https://doi.org/10.1016/j.jelectrocard.2011.11.007
Akbar, H., Foth, C., Kahloon, R. A., & Mountfort, S. (2024). Acute ST-Segment Elevation myocardial Infarction (STEMI). Statpearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532281/
Andreou, A. Y., Christou, T., & Koskina, L. E. (2021). Electrocardiographic presentation of acute left main coronary artery occlusion misinterpreted as ventricular tachycardia. Journal of Electrocardiology, 68, 7–10. https://doi.org/10.1016/j.jelectrocard.2021.06.013
Asatryan, B., Vaisnora, L., & Manavifar, N. (2019). Electrocardiographic Diagnosis of Life-Threatening STEMI equivalents. JACC Case Reports, 1(4), 666–668. https://doi.org/10.1016/j.jaccas.2019.10.030
Byrne, R. A., Rossello, X., Coughlan, J. J., Barbato, E., Berry, C., Chieffo, A., Claeys, M. J., Dan, G., Dweck, M. R., Galbraith, M., Gilard, M., Hinterbuchner, L., Jankowska, E. A., Jüni, P., Kimura, T., Kunadian, V., Leosdottir, M., Lorusso, R., Pedretti, R. F. E., . . . Zeppenfeld, K. (2023). 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal, 44(38), 3720–3826. https://doi.org/10.1093/eurheartj/ehad191
Cipriani, A., D’Amico, G., Brunello, G., Marra, M. P., Migliore, F., Cacciavillani, L., Tarantini, G., Bauce, B., Iliceto, S., Corrado, D., & Zorzi, A. (2017). The electrocardiographic “triangular QRS-ST-T waveform” pattern in patients with ST-segment elevation myocardial infarction: Incidence, pathophysiology and clinical implications. Journal of Electrocardiology, 51(1), 8–14. https://doi.org/10.1016/j.jelectrocard.2017.08.023
Escabi-Mendoza, J., Diaz-Rodriguez, P. E., & Silva-Cantillo, R. D. (2023). Shark Fin Occlusive myocardial infarction ECG pattern post-cardiac arrest misinterpreted as ventricular tachycardia. Cureus. https://doi.org/10.7759/cureus.38708
Jaiswal, A. K., & Shah, S. (2021). Shark Fin Electrocardiogram: A deadly electrocardiogram pattern in ST-Elevation myocardial Infarction (STEMI). Cureus. https://doi.org/10.7759/cureus.15989
Kukla, P., Marek Jastrzębskii, Jerzy Saccha, Leszek Brynniarrskkii, Department of Internal Medicine, H. Klimontowicz Specialistic Hospital, Gorlice, 1st Departament of Cardiology, Collegium Medicum, Jagiellonian University, Kraków, & Department of Cardiology, Medical Center, Opole. (2008). Lambda-like ST segment elevation in acute myocardial infarction – a new risk marker for ventricular fibrillation? Three case reports. Kardiologia Polska, 66, 873–877. https://journals.viamedica.pl/polish_heart_journal/article/download/80447/60171
Liroff, J., Gilbert, K., & Kim, B. S. (2016). Malignant dysrhythmias – BRUGADA Type 1 pattern formation in the presence of fever. Spartan Medical Research Journal, 1(1). https://doi.org/10.51894/001c.5072
Loubser, J., Bronislawski, L. P., Fonarov, I., & Casadesus, D. (2023). Sine-wave electrocardiogram rhythm in a patient on haemodialysis presenting with severe weakness and hyperkalaemia. BMJ Case Reports, 16(3), e255007. https://doi.org/10.1136/bcr-2023-255007
Miranda, J. M., De Oliveira, W. S., De Sá, V. P., De Sá, I. F., & Neto, N. O. (2019). Transient triangular QRS-ST-T waveform with good outcome in a patient with left main coronary artery stenosis: A case report. Journal of Electrocardiology, 54, 87–89. https://doi.org/10.1016/j.jelectrocard.2019.02.002
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., De Ferranti, S., Després, J., Fullerton, H. J., Howard, V. J., Huffman, M. D., Isasi, C. R., Jiménez, M. C., Judd, S. E., Kissela, B. M., Lichtman, J. H., Lisabeth, L. D., Liu, S., . . . Turner, M. B. (2015). Heart Disease and Stroke Statistics—2016 update. Circulation, 133(4). https://doi.org/10.1161/cir.0000000000000350
Omer, M. A., Tyler, J. M., Henry, T. D., Garberich, R., Sharkey, S. W., Schmidt, C. W., Henry, J. T., Eckman, P., Megaly, M., Brilakis, E. S., Chavez, I., Burke, N., Gössl, M., Mooney, M., Sorajja, P., Traverse, J. H., Wang, Y., Hryniewicz, K., & Garcia, S. (2020). Clinical characteristics and outcomes of STEMI patients with cardiogenic shock and cardiac arrest. КАРДИОЛОГИЯ УЗБЕКИСТАНА, 13(10), 1211–1219. https://doi.org/10.1016/j.jcin.2020.04.004
Copyright (c) 2025 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
