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BMJ Case Rep. 2018 Jul 30;2018. pii: bcr-2018-225476. doi: 10.1136/bcr-2018-225476.

Cardiac memory: an under-recognised cause of deep T wave inversion in a patient presenting with chest pain.

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Department of Cardiology, Austin Heath, Heidelberg, Australia.


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.


arrhythmias; ischaemic heart disease; pacing and electrophysiology

[Indexed for MEDLINE]

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