Discrete Lateral Infarction

Report:

Sinus rhythm 53/min

Acute (high) lateral infarction

Comment:

It often the case that in (high) lateral infarctions the most prominent early feature is the reciprocal change in the inferior leads. However, whenever ST segment elevation and depression coexist, elevation is always the primary event. As Goldberger aptly puts it, ST segment depression associated with myocardial ischaemia dies not cause reciprocal ST segment elevation except in the lead aVR24.

Below (Fig 31a) is another, quite similar example, in a 47 year old lady with typical symptoms. In both cases evolving infarction is seen in the lateral leads on subsequent days (Fig 31b).

The designation lateral is an electrocardiographic convention and does not necessarily denote the left free wall of the ventricle25. How this fits into the reciprocal changes illustrated in these two examples remains (to me, at least) unclear.

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