ST/T Infarction Getting âTransmuralâ
Report:
Sinus rhythm 90/min
Diffuse ST segment depression c/w infarction/ischæmia
Comment:
The non-Q infarction (which this was, with ongoing pain and troponins already up) did not stop here: within hours (at 3 am), a new ECG showed a conventional âhigh lateralâ infarction, with ST segment elevation in 1 and aVL (Fig 116a). The precordial leads have normalised, but this was not a good news (Fig 116b). She had a triple-vessel disease, most of it dilated and stented later on that day, but much of her myocardium was lost.
Like in politics, timing may be everything in Cardiology.
Transmural is no longer an adjective in ECG reporting: the 12-lead ECG cannot distinguish transmural from subendocardial. Nevertheless, Q waves imply larger infarcts and this patient went the full hog.
116a. the rate has slowed down, on a beta-blocker. Even a lone VEB is a late-diastolic one.
116b. Small voltage, five days later. Res ipsa loquitur.
117. 58 year old lady in (subacute) CCU, reported to have periods of silent ischæmia. She had an uncomplicated anterior infarction a week previously.
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