Cardiac Memory: A Rare Cause of Postoperative Deep T Wave Inversions

Cardiac memory (CM) is a phenomenon of electrical remodeling seen after periods of altered ventricular conduction. In this unique finding, the T wave direction during “memory”, or periods after altered depolarization, is similar to that of the QRS complex during periods of abnormal depolarization. The T wave abnormalities are commonly seen after ventricular pacing, but can also been seen with intermittent left bundle branch block (LBBB). We present a case of a high-risk elderly male who developed deep T wave inversions (TWIs) postoperatively. While ischemia is highest on the differential diagnosis in such a case, our patient was asymptomatic with negative serial troponins. Also, our patient developed the deep TWIs in the setting of an intermittent LBBB. The diagnosis of CM was made after thorough evaluation of other causes of TWIs. It is important for clinicians to be aware of CM, as it is often misinterpreted as ischemia and early diagnosis can help prevent unnecessary invasive workup. J Med Cases. 2015;6(11):520-522 doi: https://doi.org/10.14740/jmc2333w