Old Anterior and Acute Inferior Infarction
Report:
Sinus rhythm 93/min
VEB (fusion beat in V1)
Left axis deviation -60o
Left anterior hemiblock + intraventricular conduction defect
Acute inferior infarction
Right ventricular infarction
Old anterolateral infarction
Comment:
The patient had anterior MI 5 years previously due to 100% LAD artery occlusion. Now he had 100% proximal and distal RCA blocks stented and a stormy course requiring counterpulsation and inotropes, with surprisingly good eventual outcome.
The LAHB appears to be the cause of LAD, but not of most of the QRS prolongation; it is not possible – or important - to ascribe any of it to an incomplete RBBB. It’s best left as reported – LAHB + IVCD. RBBB is a sign of RV infarction, but probably not in this case.
Dominant R wave in V1 is most likely due to a posterior infarction rather than some form of RBBB. It makes the V1 rhythm strip rather decorative. It disappeared in two days’ time (Fig 63a) in the complex balance of the remaining myocardial potentials. A right ventricular infarction, obvious on the admission ECG in V1, was confirmed echocardiographically and with right-sided leads (not shown).
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Tags
left axis deviation (lad) lahb + ivcd myocardial infarction acute right ventricular old
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