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Cardiac Failure and Infarction ECG Pattern in a Chronic Alcoholic

Ivan A. D'Cruz, MD, FRCPE; Gopal G. Lalmalani, MD; Prabha V. Vaidya, MD
Arch Intern Med. 1980;140(3):391-392. doi:10.1001/archinte.1980.00330150105024.
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A 42-year-old man with a history of prolonged heavy ethyl alcohol consumption was admitted with congestive heart failure. On auscultation a gallop rhythm was heard, but no murmurs were audible. The ECG showed a pattern indicative of left atrial enlargement and old anterior wall infarction (QS pattern in V3, V4, and V5). The chest roentgenogram disclosed generalized cardiomegaly. The echocardiogram is shown in Fig 1.

What is your diagnosis?

Fig 1.—Echocardiogram showing left ventricle at mitral valve level (right) and midventricular level (left); RVAW indicates right ventricular anterior wall; ECG, electrocardiogram; VS, ventricular septum; MV, mitral valve; LVPW, left ventricular posterior wall; TH, mural thrombus. Arrows indicate paradoxical (posterior) systolic motion of left ventricular posterior wall.

Diagnosis.  Myocardial Fibrosis With Mural Thrombus in a Patient With Congestive Cardiomyopathy.The left ventricle is dilated (end-diastolic dimension, 60 mm) and shows diminished systolic excursions of the left ventricular posterior wall, as


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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