The document discusses conditions that can mimic myocardial infarction through changes in ECG readings, including WPW preexcitation, IHSS, LVH, and others. A case vignette illustrates a 62-year-old woman with a unique ECG pattern indicative of Wolff-Parkinson-White syndrome. The document emphasizes the importance of accurate ECG interpretation to differentiate these conditions.

1. PSEUDO MYOCARDIAL
INFARCTION
AIIMS BHUBANESWAR

2. ECG CONDITIONS THAT MIMIC MYOCARDIAL INFARCTION EITHER BY SIMULATING
PATHOLOGIC Q OR QS WAVES OR MIMICKING THE TYPICAL ST-T CHANGES OF ACUTE MI
• WPW preexcitation (negative delta wave may mimic pathologic Q waves)
• IHSS (septal hypertrophy may make normal septal Q waves "fatter" thereby mimicking pathologic Q waves)
• LVH (may have QS pattern or poor R wave progression in leads V1-3)
• RVH (tall R waves in V1 or V2 may mimic true posterior MI)
• Complete or incomplete LBBB (QS waves or poor R wave progression in leads V1-3)
• Pneumothorax (loss of right precordial R waves)
• Pulmonary emphysema and cor pulmonale (loss of R waves V1-3 and/or inferior Q waves with right axis deviation)
• Left anterior fascicular block (may see small q-waves in anterior chest leads)
• Acute pericarditis (the ST segment elevation may mimic acute transmural injury)
• Central nervous system disease (may mimic non-Q wave MI by causing diffuse ST-T wave changes)

3. CASE VIGNETTE
• A 62yrs woman presented with frequent episodes
of palpitation for last 7-10yrs
• Palpitation was more marked during bathing
• No other comorbidities
• ECG :RIGHT FREE WALL PATHWAY
• ECHO study was normal

4. LOCALISATION KENT BUNDLE

5. RIGHT LATERAL PATHWAY:THE WOLFF-
PARKINSON-WHITE SYNDROME
• Negative delta and negative QRS in
V1
• QS in inferior leads
• Discordant T in the inferior leads: T is
upright when there is QS in these
leads
• Left axis deviation

6. IT IS NOT TOO LATE TO LEARN AT ANY AGE