Infarct Age Undetermined — Ecg Anterior

Arun felt the familiar tightness in his chest—not his heart, but the one that came with realizing a story had already happened without anyone noticing. This wasn’t a new heart attack. The lack of ST elevation and the presence of mature Q waves meant the event had occurred at least 48 hours ago, likely longer. Days. Maybe weeks. Somewhere in the recent past, Mrs. Gable had lost a significant chunk of her left ventricular wall—the part that pumps blood to the brain, the kidneys, the rest of the body—and her body had simply… carried on.

Arun’s mind was already cataloging the implications. An old anterior infarct meant scar tissue. Scar tissue meant the heart had lost some of its contractile power. The ejection fraction could be 40%, 35%, maybe lower. She wasn’t in failure now—her lungs were clear, no edema—but she was a silent time bomb for arrhythmias, for a drop into cardiogenic shock with the next infection or dehydration. ecg anterior infarct age undetermined

Arun smiled and nodded, but his hand was already reaching for the ECG machine. Standard protocol for anyone over fifty with epigastric discomfort. He pressed the cold electrodes to her skin, her chest rising and falling in a rhythm that seemed too easy, too unremarkable for what he was about to see. Arun felt the familiar tightness in his chest—not

“Did you feel short of breath?”

He stared at the tracing. The rhythm was sinus, rate in the low seventies. But the precordial leads—V1 through V4—told a different story. There were Q waves. Wide, deep, like scooped-out riverbeds where sharp peaks should have been. The ST segments had returned to baseline, no current elevation, no reciprocal depression. But the R waves in V2 and V3 had nearly vanished, replaced by a tiny, struggling blip. Gable had lost a significant chunk of her