Acute Inferior Infarction: AIVR

Report:

Sinus rhythm

Accelerated idioventricular rhythm 88/min

Acute inferior infarction

Comment:

There are only three sinus captures present, just enough to make the diagnosis.

The computer diagnosed LBBB with “marked ST elevation – possibly due to LBBB”. In fact, true LBBB with QS complexes in the inferior leads should suggest inferior infarction, but this was not programmed into the software. Also, the repolarisation changes during the AIVR are strongly suggestive of acute infarction or ischæmia.

It is easy to see that the broad complexes are not LBBB: in V1 they show slow descent and sharper upstroke and there are narrow (sinus) capture beats.

The next day, after successful fibrinolysis at the time of the original tracing, the repolarisation changes were much less marked (below, Fig 81a).

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