Lateral Infarction: Stage of Illusion

Report:

Sinus rhythm 66/min

Within normal limits

Comment:

This ECG was taken 10 hours after the one shown below, with obvious (high) lateral infarction (Fig 4a). The patient had the benefit of primary PTCA, with excellent outcome, but his ECGs before and after the “normal” one shown here all had evolving infarct patterns.

Strictly speaking, the index ECG is not completely normal: there is T3 > T1 as possible evidence of ischæmia and borderline ST elevation à la Brugada syndrome in V1 and V2. But it could still be normal; T waves in 1 and 3 may be like this in vertical hearts and ST segment can be normally elevated in right precordial leads. The elevation was not infarctional: the precordial leads did not change over time.

The stage of illusion, when ST segments return to isoelectric line and the T waves are still upright, is a dangerous one for the patient (and his treating doctor) if he presents with it after the symptoms have resolved.

4a. The “high lateral” denomination of 1, aVL infarction is merely an ECG descriptive convention. Some centers obtain “high lateral” chest leads in this conext to confirm what they know alredy. Hobbits re-read the same books with the same pleasure in mind. 5. 46 year old lady with chest pain.

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