Embolic Anterior Infarction in Endocarditis

Report:

Sinus tachycardia 108/min

T wave changes c/w infarction/ischæmia

Comment:

Again, there are no reciprocal changes in the inferior leads. The embolus lodged distal to the first diagonal (D1) and septal (S1) branches of the LAD. This is almost invariably the location of the LAD occlusion (in single-vessel disease) when inferior leads fail to show reciprocal ST segment depression23. It also the rule in embolic infarcts from endocarditis.

Below is the tracing a day later, showing evolving anterior MI. Sometimes, involving mid-precordial leads, it’s called ‘localised anterior MI’. It’s uncommon.

It’s also most uncommon to see myocardial infarcts in 14 year olds. She had the pain at 8 pm, the ECG was taken at 9 pm and seen by both Pædiatric and Medical Registrars, without any comment or action. She was transferred to CCU in the morning! And from Canberra to Sydney two days later.

The patient did well clinically.

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