Case A9. Anterior Infarction with Lateral Ischaemia

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

The ECG was recorded from a 72 year old man who had been admitted to hospital following a myocardial infarction three weeks previously. On that occasion he had presented late (12 hours after the onset of pain). At PCI he had stents placed to lesions in the left anterior descending artery. He had a significant rise in hs-Troponin (several thousand). He was discharged to a cardiac rehabilitation program.

ECG

There are pathological Q waves in leads V2 – V4 (although there is also a Q wave in VI this may be a normal finding). There is also significant loss of R wave in the precordial leads- no R wave being recorded until V5- further evidence of infarction in this area. Tlie ST segments have returned to the isoelectric line at this stage although symmetrical T wave inversion is still present in the same leads. In the lateral leads (I, aVL, V6) the ST segments are downsloping and the T waves are inverted but there are no pathological Q waves to indicate infarction. The ST/T wave changes in these leads are compatible with ischaemia in the area adjoining the infarction.

Comment

The changes are those of recent anterior infarction. The late presentation of the patient probably contributed to the loss of myocardial muscle and subsequent development of Q waves. This patient had a significant loss of ejection fraction on ECHO.

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