Extensive Acute Anterior Infarction

Report:

Sinus rhythm 97 - 100/min

VEBs, bigeminal

Left axis deviation

Extensive (hyper)acute anterior infarction

Comment:

All the precordial leads, as well as the “lateral” 1 and aVL show ST segment elevation reciprocated by depression in the three inferior leads. Their T waves are still upright, but well on the way down in two hours (Fig 7a).

The bigeminal VEBs are clearly dissociated from the sinus P waves. After the first two VEBs, the R configuration in V1 strip changes to QR because of the overlapping P waves at their onset. This helps differentiate them from SVEBs with RBBB/LPHB aberrancy.

The elevated ST segment in V5 below is completely horizontal. This is unusual, but of no particular diagnostic significance.

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