Electrocardiogram of anomalous left coronary artery from the pulmonary artery in infants.

The electrocardiogram of an infant with anomalous left coronary artery from the pulmonary artery (ALCAPA, Bland-White-Garland syndrome) usually shows typical signs of an anterolateral myocardial infarction, manifested by abnormal Q waves in leads I, avL, V5, and V6, as well as by transient ST changes in these leads. Because 20-45% of such patients do not show abnormal Q waves, the diagnosis should be strongly suspected if there is an abnormal R wave progression in the chest leads.