Large T wave inversion and QT prolongation associated with pulmonary edema- A report of nine cases

OBJECTIVES The purpose of this study is to describe a new clinical electroc ardiographic phenomenon characterized by diffuse symmetrical T wave Inversi on and QT prolongation after recovery from an episode of cardiogenic but no nischemic pulmonary edema. BACKGROUND A variety of clinical conditions, but not acute pulmonary edema, have been previously associated with giant negative T waves and QT prolong ation in the postevent electrocardiogram. METHODS In nine patients not suspected of having ischemic heart disease, ne w large or global T wave inversion with QT prolongation was observed after resolution of acute cardiogenic pulmonary edema. Each patient underwent det ailed clinical evaluation including testing for myocardial injury and a cor onary 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 in farction and significant coronary artery disease were ruled out in each cas e. During the index event, most patients had elevated blood pressure, sinus tachycardia, minimal nonspecific ST and T wave changes and normal QT inter vals. Large inverted T waves with marked prolongation of the QT intervals e volved within 24 h after clinical stabilization. The electrocardiographic c hanges gradually resolved in one week There was no in-hospital mortality. CONCLUSIONS Acute cardiogenic but nonischemic pulmonary edema may cause dee p T wave inversion and QT prolongation after resolution of the symptoms. Th e repolarization abnormalities may last for several days. These electrocard iographic changes do not adversely effect short-term prognosis. (J Am Coll Cardiol 1999;34:1106-10) (C) 1999 by the American College of Cardiology.