Acute Anterolateral Infarction
Report:
Sinus rhythm 68/min
VEBs
Acute anterolateral infarction
Left ventricular hypertrophy voltage
Comment:
The left circumflex artery was 100% blocked, but successfully dilated and stented at the PTCA. However, a sizeable posterolateral infarction remained. The posterior portion of the infarct (also seen scintigraphically) remains invisible on the ECG. Serum troponin rose to 157 µg/L (normal < 1.0 µ/L) and CPK to 2546 U/L (normal < 200 U/L). The LAD artery was diffusely diseased and the LV function globally depressed, with LVEF 41% at a subsequent radionuclide scan. The preserved large R waves in the anterolateral leads (below, day later) were somewhat misleading, presumably reflecting previously established LVH.
The reciprocal ST segment depression in V1-3 is indistinguishable from that produced by inferior infarctions; in this case it reflects a posterolateral one.
The two VEBs are good example of fully compensatory pause: the blocked sinus P waves can be seen as wrinkles in their ST segments. Below (Fig 34a), the VEBs become bigeminal and are seen in all the leads. They have overall LBBB morphology, but with slurred S descent in V1 and unusually rightward (about +85o) frontal axis.
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