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Challenges in Clinical Electrocardiography |

Large T-Wave Inversion in a Patient With a Pacemaker

Laszlo Littmann, MD; Alex F. Fertman, MD
Arch Intern Med. 2011;171(15):1314. doi:10.1001/archinternmed.2011.358.
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A 42-year-old man with history of supraventricular tachycardia, surgical ablation, and pacemaker implantation for postoperative atrioventricular (AV) block at age 19 years, was recently hospitalized for abdominal pain, chest discomfort, nausea, vomiting, and 1 episode of hematemesis. Chest computed tomography revealed bilateral nonocclusive pulmonary emboli (PE). Findings from upper endoscopy were negative. In addition to the PEs, the patient was diagnosed as having functional dyspepsia.

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Figure 1. Admission and second-day electrocardiograms (ECGs). A, Admission ECG demonstrating sinus P waves tracked by a ventricular pacer at a long atrioventricular delay. B, A second ECG the following day shows a slightly faster sinus rate, shorter PR intervals, and normal, nonpaced QRS complexes. There are deep negative T waves in the inferior leads and in the anterolateral chest leads. Leads I and aVL are spared.

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