Transient T-wave changes in Guillain-Barré syndrome.

A 44‐year‐old woman was diagnosed with Guillain‐Barré syndrome (GBS) on day 5 after admission. She also suffered from chest pain early morning every day after admission. The severity of her GBS was Hughes functional grade four without any autonomic dysfunction. Cardiac enzymes (creatine kinase‐MB and troponin I) were not elevated; however, T waves in leads II, III, aVF, and V2 through V5 on electrocardiogram (ECG) gradually inverted (Figure 1). Oral diltiazem and a nitroglycerin patch were initiated, but these treatments did not prevent the chest pain. An echocardiogram showed normal left ventricular systolic function without regional asynergy or valve abnormality. Coronary angiography revealed normal coronary arteries without significant vasospasm following ergonovine test. After treatment with 20 g/day of intravenous immunoglobulin for 5 days, the patient's neurological symptoms gradually improved, and her chest pain disappeared after day 11. Two months later, her T waves on ECG turned to normal (Figure 1).

Figure 1

T‐wave changes in electrocardiogram during the course of Guillain‐Barré syndrome

The patient's transient T‐wave changes on ECG were apparently caused by her GBS. This phenomenon could be explained by cardiac sympathetic nerve damage theories: decreasing uptake of norepinephrine around myocytes,1 changing coronary blood flow distribution,2 and hypersensitivity of denervated myocardium to catecholamines.3 T‐wave inversion has not been recognized as a commonly observed ECG change in patients with GBS3;3 however, clinicians should also consider GBS‐related ECG changes when encountering T‐wave inversion, as in this patient. In fact, an observational study reported that T‐wave inversions were observed in 12.5% of patients with GBS.4 It is important for clinicians to be aware that GBS could accompany with these cardiac complications of chest pain and T‐wave inversion on ECG. At the same time, it is equally important to keep in mind that “GBS‐related ECG changes and chest pain” is a diagnosis of exclusion after confirming normal coronary arteries.

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.