Anterior + Inferior MI

Report:

Sinus rhythm

Left atrial abnormality (LAA)

Borderline first degree AV block

Left axis deviation (LAD) – 60o

Left anterior hemiblock (LAHB)

Incomplete right bundle branch block (RBBB)

Extensive acute anterior myocardial infarction

Acute inferior myocardial infarction

Possible old posterolateral (1, aVL, R wave in V1) myocardial infarction

Left ventricular hypertrophy (LVH)

Comment:

Judging from the original angiogram report, the catastrophe was waiting to happen. The patient was too unwell to be asked why he did not have surgery; I speculated his insurance cover was not sufficient.

Leads 3 and aVF still show rS pattern of the (possibly pre-existing) LAHB; there are also R waves in V2-3. Over the ensuing four days, these were all replaced by q or Q waves (Fig 104a), while the original Q waves in 1 and aVL have disappeared. The LVH voltage has also gone.

In inferior MIs, S waves deeper than 5 mm usually signify an associated LAHB. It is not possible to diagnose the LAHB in the trace below, but it is probably still present; a VCG (not available at the Canberra Hospital) would be able to define it.

The broad primary R wave in V1, associated with Q waves of similar width in 1 and aVL, implies a previous posterolateral MI. ST segment elevation in V1 – despite the RBBB – may signify a right ventricular infarction in the presence of acute inferior MI; it may equally well be part of the obviously extensive anterior MI. ECG is not a very reliable guide to the topography of infarction. Paul Wood said, somewhere – I quoted this before - that it matters less where the infarction is than whether one had occurred in the first place.