Old Posterior and New Inferior Infarct

Report:

Sinus rhythm 57/min

Left axis deviation

Posterior infarction, old

Recent or acute inferior infarction

Comment:

Strictly speaking, the report should have said: inferoposterior MI, ?age.

The patient had a known posterior infarction and left anterior hemiblock (Fig 57a); his left circumflex artery had been completely occluded and the LAD artery diffusely diseased. Day earlier he developed acute inferior infarction in the country and his now completely occluded RCA was stented after failed thrombolysis (“rescue PTCA”).

The new ECG (Fig 57 above) is of interest in that it shows replacement of LAHB by inferior MI as the cause of LAD. The LAHB is probably still there, with no secondary R wave in the inferior leads and one present in aVR – it’s just difficult to diagnose it on Fig 57 alone. One day after the infarction there is still some inferior ST elevation and reciprocal depression in 1 and aVL. The anteroseptal ST segments are probably immobilised by the previous large posterior infarction.

The fully developed Q waves and the inverted T waves in the inferior leads may have developed more rapidly because of the PTCA.