Pseudo-myocardial infarction pattern after aortocoronary saphenous vein bypass graft surgery : a case report

Przybojewski, J. Z. (1986-08)


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In a 51-year-old medical colleague with symptomatic atherosclerotic coronary artery disease, coronary arteriography delineated significant left mainstem, left anterior descending and left circumflex coronary artery lesions and cine angiography demonstrated normal left ventricular contractility. Aortocoronary saphenous vein bypass grafting was successful. The postoperative appearance of QS waves on the ECG suggested the possible complication of an acute transmural anteroseptal and anterolateral myocardial infarction (MI). However, this possibility was excluded by resting technetium-99m and thallium-201 scintiscans, as well as by a technetium-99m-gated blood pool scintiscan. The occurrence of acute pericarditis approximately 2 weeks after surgery made clinical evaluation more difficult. The ECG may represent a pseudo-MI pattern, the patient having suffered a post-pericardiotomy syndrome. The importance of excluding postoperative acute MI is stressed. The causes of the appearance of new Q waves after aortocoronary saphenous vein bypass graft surgery are briefly outlined.

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