Simulation of Electrocardiogram of Apicolateral Myocardial Infarction by Myocardial Destructive Lesions of Obscure Etiology (Myocardiopathy)

A myocardial destructive process unrelated to occlusive coronary arterial disease has been documented at necropsy in two patients aged 37 years and 23 years at the time of death. In the third patient, 25 years of age, electrocardiographic findings of a transmural lesion of the apicolateral wall of the left ventricle existed in the absence of evidence of impaired myocardial reserve. The nature of myocardial destruction encountered in cases 1 and 2 is compared with that in the case of parchment heart described initially by Osler. The theoretic implications of total loss of R waves in semidirect leads overlying a region of epicardial destruction are noted.