Lateral Infarction
Report:
Sinus rhythm 73/min
Acute (high) lateral infarction
Comment:
There is (typically) discrete but in this case quite definite ST segment elevation in the lateral leads 1 and aVL. Reciprocal depression is (again, typically) even more prominent in 3 and aVF. Lead 2, being 3 +1 arithmetically, remains almost normal. Pathological Q waves are already present in 1 and aVL, the latter making for a âverticalâ heart position not because the heart is vertical, as in, say, emphysema, but because of the infarctional Q wave. RAD will follow (Fig 85b).
The precordial leads are remarkably normal except for a suspicious terminal negativity in V2. The next day (Fig 85a) infarctional ST/T changes were recorded, including reversal of T wave polarity in several precordial leads. Lateral infarcts are as likely to be associated with anteroseptal as with anterolateral infarct patterns. Despite their name, they rarely represent infarction of the LV free wall60.
85a. More obvious (high) lateral infarction. Inverted T waves in 1 and aVL make the inferior T waves taller and peaked, reciprocally.
85b. Prognostically unfavourable RAD. There is also increased T inversion in the anterior leads, making this more than a âlateralâ infarction.
86. 50 year old lady with chest pain and irregular pulse.
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