Abstract
Lambda (λ) waves are uncommon ECG markers of malignant arrhythmias, usually associated with channelopathies or transient ischemia. We report a 34-year-old man with recurrent syncope preceded by subxiphoid chest pain and diaphoresis. Admission ECG showed λ-like morphology in the inferior leads with dynamic ST changes. Laboratory tests and echocardiography were normal, while Holter monitoring demonstrated persistent ST-segment depression. Coronary angiography revealed diffuse right coronary artery disease with a critical 95% stenosis, treated with drug-eluting stent placement. ECG abnormalities resolved after PCI, and syncope did not return. Serial angiography over 3.5 years confirmed sustained stent patency.