Kuniyoshi Jason, Kwock Maggie, Silangcruz Krixie, Techasatian Witina, Nishimura Yoshito
Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA.
Eur J Case Rep Intern Med. 2023 Mar 3;10(3):003798. doi: 10.12890/2023_003798. eCollection 2023.
While T-wave inversions (TWI) are associated with various pathologies, they are rarely associated with cardiac memory, termed the Chatterjee phenomenon.
A 76-year-old man with sick sinus syndrome with a pacemaker presented with chest tightness and new onset TWI in his precordial leads. On admission, he tested positive for COVID-19, but remained stable and only required minimal supplemental oxygen. His troponin was only slightly elevated, and EKG showed TWI throughout his precordial leads. A previous EKG had shown normal sinus rhythm without a paced rhythm or ST wave abnormalities. Interrogation of his pacemaker revealed an AV-paced rhythm. Given his chest tightness without dynamic changes in his troponin or EKG, the symptoms were considered more likely related to his COVID-19 infection, and he was discharged home.
Aberrancies in normal cardiac conduction can result in altered electrical activation, especially for those with AV pacemakers, leading some patients to develop cardiac memory, manifesting as TWI.
AV-paced rhythm and narrow QRS complexes with TWI localized to precordial leads without evidence of active cardiac ischaemia may suggest cardiac memory, termed the Chatterjee phenomenon, requiring no invasive interventions.
In patients with T-wave inversions, various conditions should considered in the differential diagnosis, including left bundle branch block and sick sinus syndrome, although T-wave inversions in V1-V3 are non-specific and benign.Cardiac memory, termed the Chatterjee Phenomenon, is one of the causes of T-wave inversions which is sometimes ignored.No invasive interventions are needed for T-wave inversions with the Chatterjee phenomenon.
虽然T波倒置（TWI）与多种病理情况相关，但它们很少与心脏记忆相关，即所谓的查特吉现象。
一名76岁患有病态窦房结综合征且植入起搏器的男性，出现胸痛和胸前导联新发TWI。入院时，他新冠病毒检测呈阳性，但病情稳定，仅需少量补充氧气。他的肌钙蛋白仅略有升高，心电图显示整个胸前导联出现TWI。之前的心电图显示为正常窦性心律，无起搏心律或ST段异常。对其起搏器进行问询显示为房室起搏心律。鉴于他有胸痛，但肌钙蛋白或心电图无动态变化，症状被认为更可能与他的新冠病毒感染有关，随后他出院回家。
正常心脏传导异常可导致电激活改变，尤其是对于那些有房室起搏器的患者，导致一些患者出现心脏记忆，表现为TWI。
房室起搏心律以及胸前导联局限性TWI且QRS波群狭窄且无活动性心肌缺血证据，可能提示心脏记忆，即查特吉现象，无需进行侵入性干预。
在T波倒置的患者中，鉴别诊断时应考虑多种情况，包括左束支传导阻滞和病态窦房结综合征，尽管V1 - V3导联的T波倒置是非特异性且良性的。心脏记忆，即查特吉现象，是T波倒置的原因之一，有时会被忽视。对于伴有查特吉现象的T波倒置无需进行侵入性干预。
