CVA Simulating Infarction

Report:

Sinus rhythm 92/min

Probable acute anterior infarction

Borderline ST segment elevation in the inferior leads

Comment:

There are no reciprocal changes and the QT is prolonged, but it could still be an infarct. In the context of proven cerebral hæmorrhage, however, the possibility of actual myocardial infarction becomes minuscule. There is only one report of both happening at the same time82. On the other hand, subendocardial haemorrhages have been documented in some CVAs.

The trace evolved into a broad T inversion pattern, with more obviously prolonged QT interval, the next day (111a); it was a forme fruste of giant T wave inversion. Two weeks later, it resembled ischæmic T wave inversion (111b), with narrow, deep inversion in the same set of leads.

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