Case A6. Extensive Anterolateral Infarction. St Emlyn’s ECG Library

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

The EGG was recorded from a 55 year old man who had a six month history of retrosternal chest discomfort on exertion. His symptoms had been treated as gastro-oesophageal reflux, but the addtion of antacids and proton pump inhibitors had not helped. After mowing the lawn he experienced similar pain and attended his local GP. The GP found him to be sweaty and short of breath and made the provisional diagnosis of ACS. He received aspirin and nitrates which partially relieved his symptoms. An ambulance was called where this ECG was recorded together with a BP of 90/45 in a patient who was pale, cold, sweaty and dyspnoeic with a low blood pressure 90/45. He was transferred urgently by ambulance to the Cath Lab for urgent PCI. A significant lesion in the Left Anterior Descending artery was stented. He recovered well.

ECG

This shows the typical raised ST segments of acute anterolateral infarction in leads I,II, aVL and precordial leads V2 – V6. In addition there is ‘reciprocal’ ST depression in leads III, aVF and aVR- leads that record from the opposite side of the heart There are pathological Q waves in leads 1, aVL and precordial leads V2, V3 and V4. There is extensive loss of R wave in the precordial leads – no R wave is seen at all until V5 and this is only a very small positive deflection as is the R wave in V6.

Comment

The EGG shows evidence of extensive anterolateral lnfarction and the clinical flndings are certainly compatible with left ventricular impairment resulting from this.

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