Cardiac memory: an under-recognised cause of deep T wave inversion in a patient presenting with chest pain. (30th July 2018)

• Record Type: Journal Article
• Authors: Peck, Daniel; Al-Kaisey, Ahmed
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-07-30
• Subjects: arrhythmias -- ischaemic heart disease -- pacing and electrophysiology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-225476
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : T wave inversion (TWI) has many differential diagnoses with acute myocardial ischaemia being the highest on the list of potential causes. Cardiac T wave memory is a benign, under-recognised and clinically important phenomenon seen after periods of altered ventricular conduction. After normal ventricular conduction is restored, the T wave 'remembers' and mirrors the direction of the wide QRS complex. Therefore, negative T waves are seen in leads that had negative wide QRS complexes. We describe the case of a 60-year-old truck driver with chest pain, deep TWI and traditional cardiovascular risk factors. After ruling out significant myocardial ischaemia, it was crucial to determine the cause of his T wave changes to provide reassurance and provide commercial license medical clearance. While it is currently a diagnosis of exclusion, it remains an important clinical entity for clinicians to recognise to provide an explanation for certain T wave changes to avoid future unnecessary cardiac testing.