Cerebral Mimicry of MI

Report:

Sinus tachycardia 127/min

Right atrial abnormality

VEB

Acute inferolateral (or, better, inferior + anterior) myocardial infarction

Prolonged QT interval

Comment:

The last item, QT prolongation, is the only clue that this is not an ordinary myocardial infarction. While the QT interval may be prolonged in MI (with or without QT-prolonging drugs), it is seldom as striking as here. It is best measured in lead aVL, where U waves are usually isoelectric.

In the context of an obvious cerebral insult, however, the likelihood of myocardial infarction is, in my experience, remote. In a dozen or so cases over the years (many of them in this Library), no such patient with an ECG infarction pattern had a true infarct, although one can rarely be certain in advance185. Myocardial lesions, however, are well documented in this setting, presumably as a result of a catecholamine surge186. From a practical point of view, the presence or otherwise of a myocardial infarction makes little difference: such patients are comatose, ventilated and given ‘bed rest and oxygen’ anyway.

The patient’s postoperative trace shows a fascicular VT 110/min (Fig 155a). She never woke up.

255a. 256. Asymptomatic 33 year old lady referred for evaluation of an abnormal cardiogram obtained during life insurance examination. What are her prospects?