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Cardiac memory: an under-recognised cause of deep T wave inversion in a patient presenting with chest pain
  1. Daniel Peck,
  2. Ahmed Al-Kaisey
  1. Department of Cardiology, Austin Heath, Heidelberg, Australia
  1. Correspondence to Dr Ahmed Al-Kaisey, ahmed.alkaisey{at}


T wave inversion (TWI) has many differential diagnoses with acute myocardial ischaemia being the highest on the list of potential causes. Cardiac T wave memory is a benign, under-recognised and clinically important phenomenon seen after periods of altered ventricular conduction. After normal ventricular conduction is restored, the T wave ‘remembers’ and mirrors the direction of the wide QRS complex. Therefore, negative T waves are seen in leads that had negative wide QRS complexes. We describe the case of a 60-year-old truck driver with chest pain, deep TWI and traditional cardiovascular risk factors. After ruling out significant myocardial ischaemia, it was crucial to determine the cause of his T wave changes to provide reassurance and provide commercial license medical clearance. While it is currently a diagnosis of exclusion, it remains an important clinical entity for clinicians to recognise to provide an explanation for certain T wave changes to avoid future unnecessary cardiac testing.

  • arrhythmias
  • ischaemic heart disease
  • pacing and electrophysiology

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  • Contributors DP contributed to case report writing, literature search and patient follow up. AA-K contributed to case report writing, supervision, patient consent and follow up.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.