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ECG diagnosis made easy by R J Vecht

By R J Vecht

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I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 66: The same patient presented with chest pain 4 months later. There are peaked T waves in leads V2 and V3 with some ST segment depressions in leads V3 and V4; cardiac enzyme levels were elevated (HI; 27/7/99). Ischaemic (coronary) heart disease I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 67: ECG changes resolved, with only minor lateral T wave inversions remaining. At catheterisation, the patient was found to have three vessel disease, which was treated medically (HI; 6/9/99).

P waves and QRS complexes are not connected, indicating conduction defects commonly seen with acute inferior infarction (ED; 3/8/98). I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 39: Acute inferior and anterolateral infarction. Q waves and T wave inversions are seen in leads II, III, aVF, V4, V5 and V6 (Mr R; 26/1/98). True posterior infarction True posterior infarction is rare. The dead window is situated posteriorly, therefore electrodes facing healthy tissues will record unopposed positive forces manifested by dominant R waves in leads V1 and V2 (Figure 17 and ECGs 40–41).

I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 48: Anterolateral infarction. Q waves are present in leads I and aVL. Reduced R waves are seen in leads V4, V5 and V6 and there are marked lateral T wave inversions (Mr E; 28/2/96). 36 ECG Diagnosis Made Easy I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 49: The same patient 1 month after bypass surgery, showing marked improvement in ECG indices (Mr E; 10/5/96). I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II ECG 50: A further 3 months later, there are minor residual Q waves in leads I and aVL with T wave.

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