Old Anterior MI in VT & VEBs

Report:

Ventricular tachycardia 200/min

Probable old anteroseptal infarction

Comment:

The VT has a deep Q wave, QrS morphology and associated ST elevation resembling an infarct pattern. Sometimes the previous infarct is only visible when revealed by VEBs. Note the slurred descent of the Q wave, characteristic of ventricular ectopy (as opposed to LBBB aberrancy).

The QS extrasystoles do not qualify, diagnostically, as markers of old infarction: only QR or, as here, QRS morphologies are valid72.

The same pattern is seen in the VEB shown below (Fig 77a). Other ECG features include left atrial abnormality (LAA.), borderline LAD -30o and poor R wave progression (late transition). There may even be a small q wave in V2 – sometimes contributed by a hemiblock - but in this case possibly due to infarction itself.

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