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

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

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

Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi

1. Assistant Professor, Department of Cardiology, King George's Medial University, Lucknow, Uttar Pradesh, India. 2. Assistant Professor, Department of Cardiology, King George's Medial University, Lucknow, Uttar Pradesh, India. 3. Assistant Professor, Department of Cardiology, King George's Medial University, Lucknow, Uttar Pradesh, India. 4. Professor, Department of Cardiology, King George's Medial University, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Akshyaya Pradhan,
Assistant Professor, Department of Cardiology, King George's Medial University, Lucknow-226003, Uttar Pradesh, India.
E-mail: akshyaya33@gmail.com

Abstract

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.

Keywords

Bradyarrhythmia, Cardiac memory, Coronary angiogram, ST-T changes, Transvenous pacing

How to cite this article :

Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi. “ELECTROCARDIOGRAM CHANGES WITH ELEVATED TROPONINS MIMICKING MI: ALL THAT GLITTERS IS NOT GOLD”. Journal of Clinical and Diagnostic Research [serial online] 2018 June [cited: 2018 Jun 24 ]; 12:OD08-OD09. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OD08-OD09&id=11622

DOI and Others

DOI: 10.7860/JCDR/2018/33903.11622

Date of Submission: Sep 25, 2017
Date of Peer Review: Nov 28, 2017
Date of Acceptance: Mar 12, 2018
Date of Publishing: Jun 01, 2018

FINANCIAL OR OTHER COMPETING INTERESTS: None.

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