CVA Mimics Anterior MI

Report:

Sinus rhythm 93/min

PR interval 0.09”

Acute anterior infarction/ischæmia

Also consistent with CVA

Comment:

This is a relatively frequent occurrence in severe brain injury from any cause; cerebral hæmorrhage is the leading cause at the Canberra Hospital. The presumed mechanism is massive catecholamine discharge, although (the observed) sinus tachycardia is seldom marked. In this case, the very short PR interval may be due to elevated sympathetic tone; it persisted, with different P wave morphology, the next day (Fig 101a below). The lady may have had unrelated Lown-Ganong-Levine conduction.

Absence of reciprocal changes, unfortunately, does not distinguish true infarction from the CVA pattern. One thing that would have helped is the QT prolongation, but it’s not always present. It appeared in Fig 101a, but it is not particularly striking there.

The ECG progressed as it would in infarction; the troponins, if we did them 10 years ago, would have been elevated. The new definition of infarction has deprived the term of its specificity, possibly due to lack of broader education of those who “improved” the terminology.