What is the role of ECG in the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA)?

Updated: Aug 10, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Typically, an anterolateral infarct pattern with abnormal deep (>3 mm) and wide (>30 msec) q waves is observed in leads I, aVL, V5, and V6, absent q waves in leads II, III, and aVF, and poor R wave progression across the precordial leads, with sudden shift to qR. Electrocardiography (ECG) detects abnormalities of repolarization in the form of ST-segment depression or inversion, both inferior and lateral (see the image below). The QRS axis is typically normal, although, in some cases, a left superior axis is seen.

Preoperative electrocardiogram in a 2-month-old in Preoperative electrocardiogram in a 2-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery demonstrating pathologic Q waves in leads I and aVL and diffuse ST-T wave changes consistent with an anterolateral infarction.

Following successful surgical revascularization, the ECG may revert to normal findings with the disappearance of the pathologic q waves and ST-T wave changes (see the image below).

Electrocardiogram in 2-month-old infant with anoma Electrocardiogram in 2-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery 17 months following successful surgical revascularization, demonstrating complete resolution of the anterolateral infarction pattern and ST-T wave changes.

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