Here are other cases of pseudonormalization.
A 61 y.o. female with no h/o coronary disease presented with 3 days of nausea, vomiting, 3-4 liquid stools, and shortness of breath, especially with exertion. She denies fevers, chills, cough, chest pain, chest pressure, chest heaviness, diarrhea and abdominal pain. Her risk factors are HTN, smoking, and hyperlipidemia.
Here is her initial ECG at 0508:
The Na returned at 117 mEq/L, but the troponin I returned at 8 ng/ml. So the clinicians repeated the ECG at 0742:
Pseudonormalization of T-waves: "Normalization" because upright T-waves are usually normal, but "Pseudo" because even though they are upright, the fact that they are upright in this case is indicative of coronary occlusion.
She was moved to the critical care area, and at 0810, this ECG was recorded:
The initial troponin I was 8 ng/ml, confirming that the infarct seen on the first ECG was recent. The patient went for immediate PCI of a 95% distal RCA with hazy segment due to thrombosis.
Here is the ECG after PCI:
Troponin I peaked at 18. The inferior wall was akinetic on echo.
Learning points:
1. Beware dyspnea in elderly women especially
2. Subacute MI may present with T-wave inversion with or without Q-waves
3. Subacute MI may have re-infarction
4. If T-waves of subacute MI turn upright (pseudonormalization), this is indicative of re-occlusion of the infarct-related artery
A 61 y.o. female with no h/o coronary disease presented with 3 days of nausea, vomiting, 3-4 liquid stools, and shortness of breath, especially with exertion. She denies fevers, chills, cough, chest pain, chest pressure, chest heaviness, diarrhea and abdominal pain. Her risk factors are HTN, smoking, and hyperlipidemia.
Here is her initial ECG at 0508:
The Na returned at 117 mEq/L, but the troponin I returned at 8 ng/ml. So the clinicians repeated the ECG at 0742:
Pseudonormalization of T-waves: "Normalization" because upright T-waves are usually normal, but "Pseudo" because even though they are upright, the fact that they are upright in this case is indicative of coronary occlusion.
She was moved to the critical care area, and at 0810, this ECG was recorded:
The initial troponin I was 8 ng/ml, confirming that the infarct seen on the first ECG was recent. The patient went for immediate PCI of a 95% distal RCA with hazy segment due to thrombosis.
Here is the ECG after PCI:
Not much changed from the previous. |
Troponin I peaked at 18. The inferior wall was akinetic on echo.
Learning points:
1. Beware dyspnea in elderly women especially
2. Subacute MI may present with T-wave inversion with or without Q-waves
3. Subacute MI may have re-infarction
4. If T-waves of subacute MI turn upright (pseudonormalization), this is indicative of re-occlusion of the infarct-related artery
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