ArticleJACC. Case reports2026
Pseudo-Infarction Reversal in Right Precordial Leads: ECG Evolution in Severe Pulmonary Hypertension.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAn acute pulmonary hypertension (PH) crisis causes dynamic electrocardiographic (ECG) changes, but complete post-therapy normalization-especially in post-transplant thrombotic microangiopathy (TMA) patients-is rarely documented. CASE SUMMARY: A 53-year-old man with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation presented with dyspnea. Right heart catheterization confirmed an acute pulmonary hypertension crisis (mean pulmonary arterial pressure: 52 mm Hg) secondary to thrombotic microangiopathy. Treatment with inhaled nitric oxide and treprostinil led to improvement. Follow-up echocardiography showed normalized pulmonary arterial pressure (35 mm Hg), resolution of ECG abnormalities (including a myocardial infarction pattern in the right precordial leads), and no PH recurrence.
conclusionThis case highlights TMA as a rare cause of reversible, vasoreactive PH after hematopoietic stem cell transplantation and documents the full ECG evolution during PH crisis and recovery. TAKE-HOME MESSAGES: ECG monitoring is essential for diagnosing and tracking acute PH crises in transplant patients. Post-transplant TMA can cause reversible PH, requiring prompt hemodynamic assessment and targeted therapy.
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