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Large T-Wave Inversion in a Patient With a Pacemaker

Large T-Wave Inversion in a Patient With a Pacemaker A 42-year-old man with history of supraventricular tachycardia, surgical ablation, and pacemaker implantation for postoperative atrioventricular (AV) block at age 19 years, was recently hospitalized for abdominal pain, chest discomfort, nausea, vomiting, and 1 episode of hematemesis. Chest computed tomography revealed bilateral nonocclusive pulmonary emboli (PE). Findings from upper endoscopy were negative. In addition to the PEs, the patient was diagnosed as having functional dyspepsia. Findings from cardiac examination were normal and cardiac serum markers were negative. The chest radiograph showed clear lung fields and a normal cardiac silhouette. Right atrial and right ventricular pacing leads were in the appropriate positions. A transthoracic echocardiogram was normal; there was no evidence of right ventricular strain. The admission electrocardiogram (ECG) (Figure 1A) showed a ventricular paced rhythm. A routine ECG recorded next day (Figure 1B) showed sinus rhythm with narrow QRS complexes without evidence of ventricular pacing. The QRS morphology was normal but there were deep negative T waves in the inferior and anterolateral leads. View LargeDownload Figure 1. Admission and second-day electrocardiograms (ECGs). A, Admission ECG demonstrating sinus P waves tracked by a ventricular pacer at a long atrioventricular delay. B, A second ECG the following day shows a slightly faster sinus rate, shorter PR intervals, and normal, nonpaced QRS complexes. There are deep negative T waves in the inferior leads and in the anterolateral chest leads. Leads I and aVL are spared. Question: What is the most likely cause of the large negative T waves in the second ECG tracing (Figure 1B)? Should this patient undergo cardiac catheterization for the apparent diffuse subendocardial ischemia? Answer http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Large T-Wave Inversion in a Patient With a Pacemaker

Large T-Wave Inversion in a Patient With a Pacemaker

Abstract

A 42-year-old man with history of supraventricular tachycardia, surgical ablation, and pacemaker implantation for postoperative atrioventricular (AV) block at age 19 years, was recently hospitalized for abdominal pain, chest discomfort, nausea, vomiting, and 1 episode of hematemesis. Chest computed tomography revealed bilateral nonocclusive pulmonary emboli (PE). Findings from upper endoscopy were negative. In addition to the PEs, the patient was diagnosed as having functional dyspepsia....
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2011.358
Publisher site
See Article on Publisher Site

Abstract

A 42-year-old man with history of supraventricular tachycardia, surgical ablation, and pacemaker implantation for postoperative atrioventricular (AV) block at age 19 years, was recently hospitalized for abdominal pain, chest discomfort, nausea, vomiting, and 1 episode of hematemesis. Chest computed tomography revealed bilateral nonocclusive pulmonary emboli (PE). Findings from upper endoscopy were negative. In addition to the PEs, the patient was diagnosed as having functional dyspepsia. Findings from cardiac examination were normal and cardiac serum markers were negative. The chest radiograph showed clear lung fields and a normal cardiac silhouette. Right atrial and right ventricular pacing leads were in the appropriate positions. A transthoracic echocardiogram was normal; there was no evidence of right ventricular strain. The admission electrocardiogram (ECG) (Figure 1A) showed a ventricular paced rhythm. A routine ECG recorded next day (Figure 1B) showed sinus rhythm with narrow QRS complexes without evidence of ventricular pacing. The QRS morphology was normal but there were deep negative T waves in the inferior and anterolateral leads. View LargeDownload Figure 1. Admission and second-day electrocardiograms (ECGs). A, Admission ECG demonstrating sinus P waves tracked by a ventricular pacer at a long atrioventricular delay. B, A second ECG the following day shows a slightly faster sinus rate, shorter PR intervals, and normal, nonpaced QRS complexes. There are deep negative T waves in the inferior leads and in the anterolateral chest leads. Leads I and aVL are spared. Question: What is the most likely cause of the large negative T waves in the second ECG tracing (Figure 1B)? Should this patient undergo cardiac catheterization for the apparent diffuse subendocardial ischemia? Answer

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 8, 2011

Keywords: artificial cardiac pacemaker,inverted t wave

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