Left Pneumonectomy Pseudoinfarction

Report:

Sinus rhythm 62/min

Right axis deviation +135o

Possible anterior infarction ?age

Possible cor pulmonale

Small voltage, chest leads

Comment:

The preoperative ECG was normal (Fig 15a below). The obvious question is whether a perioperative event like myocardial infarction or pulmonary embolism had taken place. This question must be posed in the actual context, where no clinical indication of any postoperative complications was present: ECG alone is not valid evidence. Especially with respect to embolism into the remaining lung causing the recorded changes, there would be hæmodynamic and gas exchange alterations of easily detectable magnitude!

Next, anyone familiar with post-pneumonectomy electrocardiography could offer the reassurance that this is, precisely, what happens after left pneumonectomy22. The anteroseptal Q waves and the prominent lateral S waves have been seen many times before in this setting.

On the chest X-ray, the heart was touching the left chest wall. The ECG reflects its new lævoposition.

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