Coexisting left anterior hemiblock and inferior wall infarction.

it would be useful to have a sensitive technique for the detection of this group of patients. The problem in the coronary care unit, however, is the separation of patients with unstable angina from those with frank infarction and with a higher risk of more immediate. life-threatening complications. It is evident from the study of Abdulla et a1 that scintigraphy for detection of acute myocar-dial infarction probably does not separate these two groups of patients. The technique is still useful, however, in separating patients with chest pain of noncardiac origin and stable angina pectoris from acute coronary insufficiency or myocardial infarction. There are still potentially important applications for this technique in the coronary care unit, however. Because of its very high sensitivity in the detection of acute infarction, a negative scintiscan obtained within six days of the onset of chest pain is quite useful in ruling out acute infarction. A potential application of this technique, particularly with the advent of interventions aimed at limiting infarct size: is the estimation of the extent of damage and hence the determination of the efficacy of these medical and surgical therapies. This approach is currently undergoing evaluation in a number of clinical centers and requires further validation. The accurate separation of patients with unstable angina from those with frank infarction by scintigraphic techniques will probably await the development of radiopharmaceuticals similar to BBmTc-tetracycline which limit their uptake to acutely necrotic tissue, but with improved biologic characteristics to enable rapid imaging such as is currently available with emTc-pyrophosphate. Comparative accuracy of 99"Tepyrophosphate, 99mTc-tetracycline and @OmTe glucoheptonate for the scintigraphio diagnosis of acute myocardial infarction. uptake of 90mTc complexes and 67Ga in acutely infarcted myocardium. study of potassium-43 and technetium-99m pyrophosphate distribution in myocardial infarction and their correlation to creatine phosphokinase (CPK) depletion. L frequent cause of abnormal left axis deviation. Equally familiar is the knowledge that inferior wall or diaphragmatic infarction can record an abnormal left axis because of the location of the infarct; however , when an inferior wall myocardial infarction occurs in a patient with left anterior hemiblock, the diagnosis of the left anterior hemiblock becomes difficult. The question arises as to whether the abnormal left axis is due to the infarction per se or is a result of the concurrent left anterior hemiblock. Moleiro and Mendoza (see page 418) present a report illustrating a rare example where the QR pattern of acute …