Case A3. Old Inferior Infarction With Lateral ST/T Wave changes. St Emlyn’s ECG Library.

Inferior Infarction stemlyns, ECG Library, #FOAMed, St. Emlyn’s ECG Library. http://www.stemlynsblog.org/ecg-library/History

The EGG was recorded from a 69 year old retired male who had consulted his GP because of increasing angina. There was a history of a ‘heart attack’ ten years previously.

ECG

There are pathological Q waves in leads II, III and aVF diagnostic of old inferior infarction. In addition there are
sagging ST segments accompanied by T wave inversion in leads I and aVL. The ST segments are also sagging in leads V5 and V6 although the T waves remain upright in these leads.

Comment

The EGG shows the changes of old inferior infarction. After ten years the Q waves remain as evidence of this; the T waves are now upright in the relevant leads. The sagging ST segments and T wave changes in the lateral leads are non specific changes but suggest ischaemia in this area. No other explanation for these changes is apparent from the EGG and the presence of old infarction provides clear evidence for the presence of ischaemic heart disease in this patient.

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