The heart remembers what the mind forgets

Acta Clin Belg. 2021 Aug;76(4):310-313. doi: 10.1080/17843286.2020.1724449. Epub 2020 Jan 30.

Abstract

Background: Cardiac memory, also known as the Chatterjee phenomenon, is a poorly understood, under-recognized but important and benign cause of T-wave inversions. After a period of abnormal ventricular activation, such as ventricular pacing, intermittent left bundle branch block or pre-excitation, the heart 'remembers' and mirrors its repolarization in the direction of the previous QRS. It usually manifests as T-wave inversions that can linger up to weeks after the provocative event.Case summary: An 87-year-old man with extensive cardiovascular history and risk factors presented to the emergency department with shortness of breath and chest pain. An ECG taken on admission revealed deep widespread T wave inversions. Serial high sensitive cardiac troponin (hs-cTn) however remained negative (<10 ng/ml) with a negative D-dimer. Upon reviewing previous ECGs and the medical history, the patient was diagnosed with cardiac memory, which required no further treatment.Conclusion: Cardiac memory should be considered in any patient with a ventricular pacemaker that presents with narrow QRS rhythm and T-wave changes suggestive of ischemia. Although it remains a diagnosis of exclusion, recognizing this important clinical entity can prevent unnecessary admissions, expensive diagnostic tests and invasive procedures.

Keywords: Cardiac memory; Chatterjee phenomenon; Chest pain; Deep T-wave inversion; Post pacing T-wave inversion.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Arrhythmias, Cardiac
  • Bundle-Branch Block*
  • Chest Pain
  • Electrocardiography*
  • Heart Ventricles
  • Humans
  • Male