Acute Inferolateral Infarction

Report:

Accelerated junctional rhythm 93/min

Acute inferolateral infarction

Comment:

There is no obvious atrial activity, dissociated or otherwise. The patient had just arrived to CCU from Casualty and the r-tPA had just been given. The rhythm was interpreted as a sign of reperfusion, although inferior infarction per se has now overtaken digitalis as a leading cause of accelerated idiofocal rhythms.

Judging by the more important criterion of early ST segment shift resolution, there was no reperfusion. Below (Fig 25a)is an ECG taken 7 days later, still showing ST elevation in the inferior leads. By now there is a new left axis deviation – 32o due to inferior Q waves. Q waves are also present in V3-6, with loss of R wave voltage.

25a. Secondary R wave in lead 2 and its absence in aVR confirm the new LAD is due inferior MI rather than LAHB.

26. Holter strips in a 90 year old lady with recurrent falls. No arrhythmia was documented, but...

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