A 52-year-old woman is described with the clinical picture of congestive heart failure, electro- and vectorcardiographic evidence of myocardial infarction, combined with angiographically hypokinetic left ventricle, but with patent coronary arteries. Endomyocardial biopsy disclosed changes consistent with 'congestive cardiomyopathy'. Thus, the study shows that the Q wave pattern on the electrocardiogram provides insufficient evidence for the diagnosis of myocardial infarction, and may be misleading in patients with cardiomyopathy. In such circumstances, endomyocardial biopsy from the left or right ventricle appears to be a helpful diagnostic method, and further use of this technique may permit a more precise diagnosis in patients with a history of myocardial infarction, but with normal coronary arteries.
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