Acute Lateral Infarction

Report:

Sinus rhythm 95/min

Acute lateral infarction

Comment:

There is an obvious acute (with upright T waves) ST segment elevation in the (high) lateral leads 1 and aVL with reciprocal changes in the inferior leads. Lead 2 shows only slight depression because it is, arithmetically, lead 1 + lead 3.

The precordial T waves are suspiciously plump and upright in V2 through V6; one could call this an anterior, rather than lateral, infarction. There is no certainty, however. It is best to keep the reports within descriptive, established, conventional limits. Lateral, as mentioned earlier, does not mean LV free wall, anyway.

The patient was in pulmonary œdema and shock, supported by mechanical ventilation and inotropes. She had advanced triple vessel disease, but underwent PTCA and stenting to the LAD artery only, a recognised but still debated strategy in emergencies64. Some anterior wall may have been salvaged, since the next day’s ECG (Fig 88a) failed to show any evolution of the precordial changes. It did show, however, voltage loss and prognostically unfavourable right axis deviation65, but no lateral Q waves.

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