cute myocardial infarction resulting from an occlusive thrombus is recognized on an electrocardiogram by ST-segment elevation. 1 Early reperfusion therapy has proved beneficial in such infarctions. 2-4 The earlier the reperfusion, the greater the benefit, and the time to treatment is now considered to indicate the quality of care. These days, when thrombolytic treatment and percutaneous intervention are carried out so readily, it is important to remember that acute infarction is not the only cause of ST-segment elevation. The purpose of this review is to describe other conditions that mimic infarction and emphasize the electrocardiographic clues that can be used to differentiate them from true infarction.

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Few if any medical decisions are of more urgent importance than the accurate discrimination between ventricular tachycardia and supraventricular tachycardia with ventricular aberration, and probably no common diagnosis is more often missed. Yet the distinction can often be readily made with a knowledge of the several clues here described. These include QRS morphology, polarity and width; and clinical or electrocardiographic evidence of independent atrial activity. Knowledge and application of these serviceable clues should enable the clinician to establish a correct diagnosis in 90% of wide-QRS tachycardias without resorting to invasive studies.

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Complete heart block implies an absolute independence between atria and ventricles that does not in fact always exist. Segers showed that, after complete block was artificially produced in the frog's heart, atria and ventricles would sometimes begin to beat exactly in phase, most commonly in a 2 to 1 ratio. He subsequently reported one clinical example of 2 to 1 A-V synchronization in a patient with complete heart block. Two further cases that may illustrate different varieties of synchronization are here presented.