ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH PAPILLARY MUSCLE INFARCTION IN CONGENITAL HEART DISEASE

The electrocardiograms of 18 infants and children with congenital heart disease (4 with aortic stenosis and 14 with total anomalous pulmonary venous connection) and necropsy evidence of infarction of the papillary muscle or free wall, or both, were reviewed. In the presence of left ventricular hypertrophy, a Q wave in lead V3R followed by a small R wave is strong evidence of infarction of the anterior left papillary muscle or anterior left ventricular free wall, or both. When associated with serially diminishing amplitude of the R wave in lead V3R this is diagnostic of infarction. In the presence of right ventricular hypertrophy a Q wave in lead V3R may be due to the hypertrophy. The finding of a serially diminishing R wave in this lead, however, is evidence of infarction of the anterior right papillary muscles or anterior right ventricular free wall. Hence, with left ventricular hypertrophy or right ventricular hypertrophy a Q wave in lead V3R assumes diagnostic significance for infarction when accompanied by a diminishing R wave amplitude over the right precordial leads. © 1969.