Adv. Cardiol., vol. 19, pp. 132-135 (Karger, Basel 1977)

Partial Asystole in EeG H. ABEL and W. TILLING

SCHUTZ [2] noticed at first that it is possible to see dislocations of the ST distances in BCG if a monophasic action potential in a part of the excited myocard fibre occurs. SCHAEFER [1] realized that this fact is always combined with a stop of the excitation in the fibres, either damaged or in other conditions, which caused a partial asystole. A partial asystole is to be discussed in transient absence of R wave or if the acute phase of a myocard infarction is persistent, or changes to normal after short time. In the acute phase of a myocard infarction a partial asystole exists every time but also after injury (operation, stab, gunshot), rarely in general aggravation of the conduction of the excitement and very seldom if a part of the myocardium is insensitive to the excitation. Here and there, we found a transient partial asystole in angina pectoris missing a myocardial infarction definitively. I have seen two patients with such conditions during the last 15 years. The situation of the partial asystole existed about 24 h only. Recently, SIMONSON [3] reported about two patients with a transient absence of the R wave. In one of these, a myocardial infarction developed at last, in the other case an infarction could not be excluded. In a third patient, SIMONSON noticed a partial asystole after a coronary bypass operation. Here, I want to report about a patient who demonstrated the signs of an acute myocardial infarction in BCG over more than one year. This patient, a 62-year-old woman, had only little trouble with angina pectoris with tachycardia for several minutes. These troubles existed over many years as far she remembered. The lungs were healthy. The heart had a normal configuration without pathological sounds. The blood pressure was 120-150 mm Hg systolic and

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Medical Clinic St. Iosefs-Hospital, Wiesbaden, and Medical Clinic Hetzelstift, Neustadt a. d. W.

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80-90 mm Hg diastolic value. The heart ferments were normal. The cymogram demonstrated a resting zone supraapical with a total reduction of the ventricle wall movement. The leads of Einthoven are normal without any remarkable changes (fig. 1). In the chest leads of Wilson (V2-V5), we see the acute phase of myocardial infarction with absence of the R wave, ST elevation, high T wave and conduction delay in V2-V4. In the orthogonal lead, there is an accentuated Q and a light ST elevation with a large dumpy T wave. These conditions remain constant after ergometer exercise with a heart rate of more than 120 beats/min. In ECG controls over more than one year, these findings were constant. The troubles of the patient disappeared after a treatment with P-blockers and glycosids. Of course, there is a partial asystole in the heart of this patient, since when it is not possible to fix. Previously, there were no ECGs recorded. Exact information about the beginning of the troubles are not possible to perceive. An acute necrosis does not exist, of course. This circumscribed part of the anterior wall of the heart is insensitive to the excitation for reasons unknown. We have constantly seen these alterations over more than one year. It was not possible for us to get a coronarogram till now. But if the result

ABEL/TILLING

134

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of this angiogram is negative, as I believe, speculation remains open. I hope that I am able to give the result in the next years. At the moment, I only want to point out that this curve is not only typical for an acute myocardial infarction.

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Fig. 1. ECG of a 62-year-old woman with a partial asystole.

Partial Asystole in EeG

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References

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SCHAEFER, H,: Das Elektrokardiogramm (Springer, Berlin 1951), SCHUTZ, E,: Eiektrophysiologie des Herzens bei einphasischer Ableitung, Ergem, Physiol. 38: 493 (1936), SIMONSON, E, and BERMAN, R,: Hans Schaefer's asystoies. Two case reports, Z. Kardiol. 64: 12 (1975),

Prof, Dr. H. ABEL, St, losefs-Hospital, Medizinische Klinik, Solmsstrasse 15, Am Langenbeckpiatz, D-62 Wiesbaden (FRG)

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