Cardiac memory: Mechanisms and clinical implications

Patberg, Kornelis W.; Shvilkin, Alexei; Plotnikov, Alexei N.; Chandra, Parag; Josephson, Mark E.; Rosen, Michael R.

doi:10.1016/j.hrthm.2005.08.021

Cited by 51 publications

(37 citation statements)

References 26 publications

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“…This may again be partly due to the more straightforward identification of the end of the T-wave at times when T-waves were no longer flattened. It is also possible that the influence of hypoglycaemia on the QT interval becomes more evident after a certain time delay due to the cardiac memory effect [26]. The existence of this phenomenon will require further experimental evaluation.…”

Section: Discussionmentioning

confidence: 99%

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

et al. 2007

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Aims/hypothesis Nocturnal hypoglycaemia may contribute to sudden death in diabetic patients. However, it is not well known why hypoglycaemia makes these patients prone to death. Methods We assessed the effects of controlled hypoglycaemia on cardiac repolarisation using novel electrocardiographic descriptors of T-wave and QRS complex morphology in 16 type 1 diabetic patients and eight healthy counterparts. Several electrocardiographic variables characterising repolarisation were analysed from digitised 12-lead electrocardiograms during a euglycaemic and a hypoglycaemic clamp. Results Hypoglycaemia did not result in significant changes either in the QT interval corrected for heart rate by the nomogram method or in QT dispersion. However, the morphology of the T-wave changed significantly during hypoglycaemia. The T-wave amplitude and area in precordial leads decreased significantly in both groups (p<0.05 to p<0.001). The spatial QRS-T angle (total cosine R to T) (p<0.05) and the height and the width of the T-wave loop (p<0.05 and p<0.01, respectively) were also reduced in the diabetic patients. The changes in the repolarisation parameters did not exhibit any significant association with changes in catecholamine levels or in heart rate variability in either group. Conclusions/interpretation Hypoglycaemia results in distinct alterations in cardiac repolarisation, which may increase the vulnerability to arrhythmic events.

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Section: Discussionmentioning

confidence: 99%

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

et al. 2007

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“…The resumed sinus or the intrinsic rhythm T wave tracks the QRS vector of the preceding abnormal impulse [1]. patient.…”

Section: Discussionmentioning

confidence: 98%

The Heart Remembers: Anterior T wave inversions in a Patient with Intermittent Left Bundle Branch Block

Manne¹

2017

Int J Clin Cardiol

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Even though the new onset of T wave inversions on the electrocardiogram is always an alarming finding, but they are not always pathognomonic of myocardial ischemia. Many cardiac and non-cardiac conditions have been described in association with T wave inversions on the electrocardiogram. Cardiac memory is a phenomenon characterized by the development of altered T wave polarity on the electrocardiogram when the intrinsic rhythm resumes after a period of abnormal myocardial activation. Misdiagnosis of this condition often leads to unwarranted diagnostic workup and therapeutic interventions. Herein we report a case of 81-year-old female patient with intermittent left bundle branch block presenting with new onset T wave inversions in anterior leads. Keywords Cardiac memory, T wave inversions, Left bundle branch blockCase RepoRt left bundle branch block presenting with T wave inversions in anterior leads. Case PresentationAn 81-year-old female with dyslipidemia and hypertension presented with a two day history of aching left arm and left shoulder pain. She denied any other symptoms. Upon admission she was registering a blood pressure of 140/66 mmHg, heart rate of 90 beats/min, respiratory rate of 24/min and oxygen saturation of 95% on room air. Physical examination was unremarkable except for tenderness and limited range of motion at the left shoulder. Admission ECG obtained (Figure 1) demonstrates sinus rhythm with a rate of 90 beats/minute and T wave inversions in the anterior leads V1-V3. An ECG (Figure 2) obtained 2 months ago showed sinus rhythm with a rate of 100 beats/min and left bundle branch block.Serial troponin I levels (ng/L) measured were less than 16 ng/L (lab reference 0-45 ng/L). All laboratory data including the electrolytes and D-dimer were within normal limits. She had a cardiac catheterization two months ago for chest pain and shortness of breath which showed no coronary artery disease. A transthoracic echocardiogram revealed normal ejection fraction with no wall motion abnormalities. An X-ray of left shoulder joint showed degenerative osteoarthritis and with intraarticular steroid injection her pain significantly improved. A repeat ECG (Figure 3) obtained on the next day showed complete resolution of the anterior T wave inversions and resumption of left bundle branch block.

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“…The transient outward current seems to play a part in both short term and long term memory. [4][5][6][7] In conclusion, CM should always be kept in mind and considered in the differential diagnosis if one sees spontaneous TWI that occurs after ventricular pacing, left bundle branch block, ventricular tachycardia, and ablation of manifest pre-exitation, namely after situations that give rise to changed cardiac repolarisation. Emergency physicians and cardiologists should be aware of CM before contemplating examinations and unnecessary treatments concerning acute coronary syndrome and other disease entities.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous T wave inversion after ventricular pacing: What is the probable mechanism?

Erdoğan

2006

Postgraduate Medical Journal

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Cardiac memory: Mechanisms and clinical implications

Cited by 51 publications

References 26 publications

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

The Heart Remembers: Anterior T wave inversions in a Patient with Intermittent Left Bundle Branch Block

Spontaneous T wave inversion after ventricular pacing: What is the probable mechanism?

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