The heart remembers what the mind forgets.

Background: Cardiac memory, also known as the Chatterjee phenomenon, is a poorly understood, under-recognized but important and benign cause of T-wave inversions. After a period of abnormal ventricular activation, such as ventricular pacing, intermittent left bundle branch block or pre-excitation, the heart 'remembers' and mirrors its repolarization in the direction of the previous QRS. It usually manifests as T-wave inversions that can linger up to weeks after the provocative event.Case summary: An 87-year-old man with extensive cardiovascular history and risk factors presented to the emergency department with shortness of breath and chest pain. An ECG taken on admission revealed deep widespread T wave inversions. Serial high sensitive cardiac troponin (hs-cTn) however remained negative (<10 ng/ml) with a negative D-dimer. Upon reviewing previous ECGs and the medical history, the patient was diagnosed with cardiac memory, which required no further treatment.Conclusion: Cardiac memory should be considered in any patient with a ventricular pacemaker that presents with narrow QRS rhythm and T-wave changes suggestive of ischemia. Although it remains a diagnosis of exclusion, recognizing this important clinical entity can prevent unnecessary admissions, expensive diagnostic tests and invasive procedures.

Cryptogenic stroke in the presence of venous bronchopulmonary collateralisation.

We report the case of a 37-year-old man with a history of Hodgkin lymphoma and paroxysmal atrial fibrillation, seen because of a transient ischaemic attack with symptoms of temporary aphasia. Transoesophageal echocardiography could not detect a patent foramen ovale. However, CT thorax and flebography showed bilateral occlusion of both subclavian veins and the superior vena cava with an important collateral venous network, most likely responsible for this rare case of acquired cryptogenic stroke.