Letter by Millar and Makanjee Regarding Article, “Masking Inferior Infarction by Anterior Myocardial Injury”

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HomeCirculationVol. 115, No. 7Letter by Millar and Makanjee Regarding Article, “Masking Inferior Infarction by Anterior Myocardial Injury” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Millar and Makanjee Regarding Article, “Masking Inferior Infarction by Anterior Myocardial Injury” Rob Scott Millar, MB, BCh, FCP(SA) and Bhavanesh Makanjee, MB, BCh, FCP(SA) Rob Scott MillarRob Scott Millar Department of Medicine, Division of Cardiology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Search for more papers by this author and Bhavanesh MakanjeeBhavanesh Makanjee Department of Medicine, Division of Cardiology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Search for more papers by this author Originally published20 Feb 2007https://doi.org/10.1161/CIRCULATIONAHA.106.661314Circulation. 2007;115:e202To the Editor:Drs Deng and Das1 have provided ECGs showing the apparent disappearance and reappearance of signs of old inferior myocardial infarction during transient ischemia of the anterolateral left ventricle. They ascribe this to electrical forces in 1 zone reciprocally changing the QRS vector in the opposite myocardial zone. We believe there is an alternative explanation.Figures 1 and 3 of the original article both show pathological Q waves in leads II, III, and aVF, whereas these are absent in Figure 2, which shows transient Q waves in leads I and aVL. It is unusual for pathological Q waves to come and go in this manner, particularly in the absence of biochemical evidence for infarction. One possible mechanism for loss of inferior Q waves is left anterior fascicular block, but this does not seem to have occurred in this case.An alternative explanation is that the ECG in Figure 2 was recorded with the left-arm and left-leg electrodes transposed. In this situation, lead I becomes lead II, lead III is inverted, and aVF becomes aVL. aVR does not change significantly. The pattern recorded in the second ECG is compatible with this phenomenon.DisclosuresNone.1 Deng C, Das B. Masking inferior infarction by anterior myocardial injury. Circulation. 2006; 114: e62–e63.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails February 20, 2007Vol 115, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.661314PMID: 17309925 Originally publishedFebruary 20, 2007 PDF download Advertisement SubjectsElectrocardiology (ECG)Myocardial Infarction