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CLINICAL STUDIES

Large T wave inversion and QT prolongation associated with pulmonary edema

A report of nine cases

^a Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA

Manuscript received January 14, 1999; revised manuscript received May 4, 1999, accepted June 11, 1999.

Reprint requests and correspondence: Dr. Laszlo Littmann, Department of Internal Medicine, Carolinas Medical Center, P. O. Box 32861, Charlotte, NC 28232., USA
llittmann{at}carolinas.org

OBJECTIVES

The purpose of this study is to describe a new clinical electrocardiographic phenomenon characterized by diffuse symmetrical T wave inversion and QT prolongation after recovery from an episode of cardiogenic but nonischemic pulmonary edema.

BACKGROUND

A variety of clinical conditions, but not acute pulmonary edema, have been previously associated with giant negative T waves and QT prolongation in the postevent electrocardiogram.

METHODS

In nine patients not suspected of having ischemic heart disease, new large or global T wave inversion with QT prolongation was observed after resolution of acute cardiogenic pulmonary edema. Each patient underwent detailed clinical evaluation including testing for myocardial injury and a coronary ischemic etiology.

RESULTS

There were seven women and two men with ages ranging from 32 to 79 years. The etiology of pulmonary edema was diverse, but acute myocardial infarction and significant coronary artery disease were ruled out in each case. During the index event, most patients had elevated blood pressure, sinus tachycardia, minimal nonspecific ST and T wave changes and normal QT intervals. Large inverted T waves with marked prolongation of the QT intervals evolved within 24 h after clinical stabilization. The electrocardiographic changes gradually resolved in one week. There was no in-hospital mortality.

CONCLUSIONS

Acute cardiogenic but nonischemic pulmonary edema may cause deep T wave inversion and QT prolongation after resolution of the symptoms. The repolarization abnormalities may last for several days. These electrocardiographic changes do not adversely effect short-term prognosis.

Abbreviations and Acronyms   CHF = congestive heart failure   CK-MB = creatine kinase-MB   ECG = electrocardiogram