Question 9

Describe the major change(s) between the initial ECG (R_0025_A) and an ECG taken one week later (R_0025_B) in a 67 year old man admitted to hospital with an acute myocardial infarct.

 

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The initial ECG shows acute myocardial infarction with:

  • Q waves and ST segment elevation in Lead I, Lead aVL and Leads V2 to V5.
  • ST depression in Lead III and Lead aVF
  • Normal frontal axis

The ECG seven days later shows progression of the changes with:

  • Q waves and ST segment elevation in Lead I, Lead aVL and Leads V2 to V4, and T wave inversion in Lead I and Lead aVL
  • Reduced amplitude of the R wave in Lead V5 and Lead V6
  • Left axis deviation

Important Point:

Development of left axis deviation due to acute myocardial infarction damaging the left anterior fascicular division of the left bundle branch