Case A10. Recent Anterior Infarction with Old Inferior Infarction. St Emlyn’s ECG Library

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The ECG was recorded from a 66 year old woman two weeks after an anterior myocardial infarct. There was a history of previous myocardial infarction four years earlier.


There are pathological Q waves in leads II, III and aVF signifying inferior infarction. In addition there are
pathological Q waves in leads V2 – V4. (close inspection reveals a small R wave in V4 before the predominantly negative deflection so this is an S wave, not a Qwave). There is loss of R wave in the precordial leads- no R wave appears until V4 and the deflections in both this and V5 are very small, providing additional evidence of infarcuon in this area. The ST segments in the anterior leads have not quite returned to the isoelectric line at this stage and T wave inversion is present. T wave inversion is also present in the lateral leads (I, aVL, V5 and V6). There are no Q waves in these leads but there is loss of R wave in V5 (and possibly V6 although it is not possible to be sure without a previous record for comparison). With the other evidence of ischaemic disease provided by the ECC these lateral T wave changes almost certainly reflect ischaemia or
infarction in this territory.


The changes in the anterior leads are those of a fairly recent infarction. The Q waves in the inferior leads date from her previous infarct four years earlier and at this stage the T waves in the inferior leads have resumed their upright position.


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