Benign persistent T-wave inversion mimicking ischemia after left bundle-branch block--cardiac memory

The American Journal of Emergency Medicine
Richard Byrne, Lisa Filippone

Abstract

The electrocardiographic presence of deep T-wave inversions in a patient presenting with chest pain is highly concerning for cardiac ischemia. There are certain situations, however, when this finding may represent a benign phenomenon. In this report, we illustrate a case of non- ischemia-related T-wave inversion after resolution of a rate-related left bundle-branch block pattern--a case of cardiac memory. This poorly understood process occurs when the heart resumes a sinus rhythm after a period of abnormal depolarization, typically a bundle-branch block or ventricular pacing. The precordial leads in these patients will demonstrate alarmingly deep, symmetrical T-wave inversions. As our case demonstrates, however, this finding is an expected consequence of the antecedent aberrant conduction pattern and has no correlation with the presence of ongoing myocardial ischemia.

References

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Citations

Jun 15, 2016·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·George BazoukisPanagiotis Korantzopoulos
Aug 31, 2014·Journal of Electrocardiology·Laszlo LittmannPriscilla M Givens
Apr 23, 2015·Circulation. Arrhythmia and Electrophysiology·Alexei ShvilkinMark E Josephson
Sep 29, 2019·Herzschrittmachertherapie & Elektrophysiologie·Wolfram GrimmMariana Parahuleva

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