Case A2. Acute Anterolateral infarction. St Emlyn’s ECG Library.

stemlyns, ECG Library, #FOAMedHistory

The ECG was recorded from a 45 year old male who developed retrosternal chest pain during an office meeting. A raised blood pressure had been discovered during a company medical three years previously but he had not seen his GP about this and was not on any antihypertensive medication at the time of the chest pain.

ECG

There are raised ST segments in leads II, III and aVF and in addition there are pathological Q waves in these leads: these findings demonsteate and acute inferior infarction. The R waves in leads V4, V5 and V6 appear smaller than one would expect, especially given the size of the R waves in other leads that face the left ventricle – I and aVL. The R wave in lead V4 is smaller than the R wave in both V3 and V5 providing clear evidence that there has been loss of R wave in the lateral precordial leads. The ST segments are morphologically abnormal and slightly raised in these lateral precordial leads. The ECG evidence suggests that infarction involves the lateral surface of the heart as well as the inferior surface.

Comment

The inferior and lateral surface of the heart often share a common blood supply and both areas may be affected during infarction. This patient was transferred to the cath lab for an urgent PCI. On angiography this patient showed a large circumflex coronary artery that had become occluded. The patient received coronary stents.

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