“Electrocardiogram Changes with Elevated Troponins Mimicking MI: All that Glitters is not Gold”
Journal Title: Journal of Clinical and Diagnostic Research - Year 2018, Vol 12, Issue 6
Abstract
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 arrhythmias 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.
Authors and Affiliations
Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi
Keywords
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- EP ID EP524316
- DOI 10.7860/JCDR/2018/33903.11622
- Views 82
- Downloads 0
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