Voir la suite de cet article sur Cursus ECG
Patient
52-year-old woman, diabetic, hospitalized for chest pain at H + 3;
Trace
Anteroseptal infarction with elevation in V1-V3; minimal elevation in aVR and aVL; reciprocal depression in V4-V6 and in the inferior leads; coronary angiography revealed an occlusion of the proximal LAD upstream of the first septal branch;
Trace
79-year-old man hospitalized for chest pain at H + 3; isolated ST-segment elevation in aVR; reciprocal depression in the inferior leads, lead I and from V2 to V5; coronary angiography showed a sub-occlusion of the left coronary trunk;
Trace
74-year-old man hospitalized for chest pain at H + 5; ST-segment elevation from V1 to V4 and in leads I, aVL; reciprocal depression in the inferior leads; necrosis Q-wave and poor R wave progression from V1 to V3; coronary angiography showed an occlusion of the LAD upstream of the first septal branch;
Trace
54-year-old man hospitalized for chest pain at H + 3; ST-segment elevation from V1 to V4, in leads I, aVL and aVR; reciprocal depression in the inferior leads and in V5-V6; taller elevation in aVL than in aVR; taller ST depression in lead III than in lead II; coronary angiography showed an occlusion of the LAD upstream of the first septal branch;
Trace
81-year-old man hospitalized for chest pain at H + 6; ST-segment elevation from V1 to V5 and in leads I, aVL; reciprocal depression in the inferior leads; necrosis Q-wave and poor R wave progression from V1 to V3; coronary angiography showed an occlusion of the LAD upstream of the first septal branch;
Trace
64-year-old patient, with no risk factors, hospitalized for chest pain; sinus rhythm, normal PR interval; discrete elevation in the upper lateral territory (leads I, aVL) with minimal mirror depression in leads III, aVR and V1; coronary angiography showed an occlusion of a first diagonal branch originating from the LAD;
Trace
67-year-old man, hypertensive, hospitalized for chest pain at H + 5; elevation from V2 to V5 of large amplitude from V2 to V4 with Q-wave in these leads; absence of reciprocal depression in the inferior leads; isoelectric ST-segment in leads I, aVL and aVR; the coronary angiography revealed an occlusion of the distal LAD (downstream of the first diagonal branch);
Trace
53-year-old man, hypertensive, smoker, overweight, hospitalized for chest pain at H + 8; elevation from V2 to V5 of large amplitude from V2 to V4 with long QT and biphasic T-waves (positive/negative); Q-waves in these leads; absence of reciprocal depression in the inferior leads; isoelectric ST-segment in leads I, aVL and aVR; coronary angiography revealed an occlusion of the distal LAD (downstream of the first diagonal branch);
Exergue
The severity and prognosis of the anterior infarction is dependent on the proximal or distal nature of the coronary occlusion, which can be estimated from the surface electrocardiogram. The electrical pattern is dependent, however, on the anatomical characteristics of the patient and the presence of a collateral network.
Anterior infarctions include septal, apical and lateral infarctions in conjunction with an occlusion of the common trunk of the left coronary artery, of one of its branches (anterior interventricular or circumflex artery) or one of their divisions (septal, diagonal or marginal).