Anterior and Inferior Infarction

Report:

Sinus rhythm 95/min

Left axis deviation -40o

Borderline low voltage in frontal leads

Old inferior infarction

Anterior infarction, age indeterminate

Comment:

One cannot add “consistent with ventricular aneurysm” without knowing the history. But of course it is: months after the MI there is persistent ST segment elevation in V1-5. Most LV aneurysms are anterior; some are basal. There is no ST segment evidence in this case for inferior or posterior aneurysm. In Casualty, the best way of distinguishing acute anterior infarction from aneurysmal ST elevation is to average T/QRS ratio in V1-4, with cutoff for acute infarction at > 0.2278. In this case it is about 0.05.

The combination of inferior and anterior Q waves may suggest apical aneurysm, but in this case the aneurysm involved the anterior wall and some of the septum (most of them do)79.

110. 83 year old man on routine Outpatiens visit.

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Ischaemia

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