Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Case report
Table of Contents - Year : 2018 | Month : June | Volume : 12 | Issue : 6 | Page : OD08 - OD09

“Electrocardiogram Changes with Elevated Troponins Mimicking MI: All that Glitters is not Gold” OD08-OD09

Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi

Dr. Akshyaya Pradhan,
Assistant Professor, Department of Cardiology, King George's Medial University, Lucknow-226003, Uttar Pradesh, India.

Temporary transvenous pacing is often required as life saving measure in conditions such as Stokes Adams attack and symptomatic bradyarrhythmias. Bradyarrhythmias are also known complications of acute Myocardial Infarction (MI), which can be transient or persistent and often demand temporary pacing too. It is difficult to diagnose underlying MI in the setting of paced rhythm due to secondary ST-T changes. Elevated cardiac enzymes are essential in the scenario of paced rhythm to diagnose underlying acute MI. Remarkable T wave inversion and ST depression {similar to Left Bundle Branch Block (LBBB)} do occur in right ventricular paced ECG and some changes may persist following withdrawal of pacing (cardiac memory T waves) simulating ischaemia. Very rarely arrhythmia’s can also lead to troponin rise causing diagnostic dilemma in such a setting. Here, we report a case of an elderly female who presented with symptomatic Complete Heart Block (CHB) and developed T wave inversion with Q wave formation in anterior leads in sinus rhythm following temporary pacing. She also demonstrated a dynamic rise in serial cardiac troponin values mimicking an acute coronary syndrome. Ultimately an invasive coronary angiogram was performed to rule of significant coronary artery disease.