Septal infarction with recovery of the electrocardiogram.

The different electrocardiographic patterns that are associated with infarction of various parts of the heart are widely recognized today. This knowledge has been acquired from numerous studies correlating the electrocardiograms recorded during life with the position of the pathological changes found in the heart at necropsy. In general the management and prognosis of cardiac infarction depends upon the extent of the damage sustained by the heart; the anatomical site of infarction seems to be relatively unimportant in this respect. The description of yet another " type" of cardiac infarction would therefore appear to be of little practical importance. Recently, however, several patients have been observed in whom unusual electrocardiographic features were associated with the infarction of a particular part of the heart-namely the interventricular septum. The clinical features of these patients were also rather unusual in certain respects. Five such patients are described in this paper; in each instance chest pain was accompanied by an abnormal electrocardiogram, so that a diagnosis of cardiac infarction was made. All the electrocardiograms showed a consistent and distinctive pattern; the initial abnormalities were similar, and the subsequent behaviour was surprising, for all reverted to normal leaving no trace of the previous infarction. Two of the patients died later, and post-mortem examinations were made. From an analysis of the case histories, clinical findings, electrocardiograms, and the available evidence at necropsy, certain facts have emerged that seem worth recording.