Acute Anteroseptal and Old Inferior Infarction
Report:
Sinus rhythm 70/min
Left axis deviation â 70o
Old inferior infarction & LAHB
Acute anteroseptal infarction
Comment:
The evidence for old inferior MI (known to have occurred 7 years previously) is minute Q wave in the last complex of leads 2 and aVF preceding the equally minute r wave. The hemiblock is responsible for the lack of secondary R waves in the inferior leads and their presence in aVR, as well as the RS morphology of V6.
Even without associated ST elevation in 1 and aVL (there is a soupçon of it in the latter), marked inferior reciprocal changes indicate the presence of a proximal LAD occlusion.
Evolving changes the next day are shown below (Fig 40a). Old inferior infarct is now manifest as slurred S waves descent in inferior leads; perhaps it contributes to the small voltage there, despite the hemiblock
Fig 40a.
41. 56 year old man with chest pain.
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