Anterior Infarction From the First and Last Smoke

Report:

Sinus rhythm 55/min

Old anteroseptal infarction

Comment:

This is a rather unremarkable outpatient tracing, showing QS complexes in V1-2, very small R in V3 and abnormal T waves in 1 and aVL. There is no “septal” q wave in a small V6 complex – another sign of septal MI.

The tracing is here because of its history: the patient lit his first smoke ever, at the age of 54, and experienced symptoms of his (also first) infarction while still smoking it.

One has to feel sorry for him, being so good for so long. The physiology of acute nicotine effects is well known39, but not extensively referenced in the literature40.

The original admission ECG, with acute infarction, from three months earlier, is shown below (fig 45a). He did well, home in three days following a proximal LAD stent.

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