Case A1. Recent Myocardial Infarction. St Emlyn’s ECG Library

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This ECG was recorded from a 60 year old farmer who complained of indigestion and nausea after a heavy meal. When a period of rest and antacids have proved ineffective, his wide summoned his general practitioner who admitted him to hospital.

What does this ECG show?

The ECG shows the raised ST segments of acute infarction in leads II, III and aVF. There are pathological Q waves in leads III and aVF. The ST segments in leads I and aVL show a sagging appearance and the T waves are inverted in these leads. These represent reciprocal changes which make acute myocardial infarction more likley. The T wave is flat in V6.

Comments

The ECG shows recent inferior infarction. In addition the changes in the lateral leads are compatible with lateral ischaemia. Symptoms that initially suggest a gastro-intestinal cause are common in inferior infarction and the ECG may help distinguish gastric from cardiac pain. The risk of cardiac arrest in acute infarction is greatest in the early stages, soon after the onset of symptoms; all personnel who care for these patients should be competent in ALS protocols.

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