The presence of a notch in the ascending limb of the leads I, aVL or V6 is called Chapman's sign.

  It is one of the criteria that are used to diagnose
acute myocardial infarction

      in the presence of Left Bundle Branch Block (
LBBB).

  In patients with additional clinical findings, the
Chapman's sign may suggest the diagnosis of

      acute myocardial infarction.

  It may also be seen in some patients with LBBB and
Dilated CardioMyoPathy (normal or near-normal

      coronary arteries, and left ventricular dilation and systolic dysfunction.







ECG 1.
Chapman's sign during acute myocardial infarction of a patient with pre-existing LBBB.

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ECG 2.
Chapman's sign and LBBB are seen in the above ECG from a 70 years-old woman.

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ECG 3.
Chapman's sign and LBBB are seen in the above ECG from a 70 years-old man with old myocardial infarction.

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ECG 4.
Chapman's sign and LBBB in another patient.

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ECG 5. The ECG above is from a 56 yers-old woman with minimal coronary artery disease, and
left ventricular systolic dysfunction and dilation (Dilated CardioMyoPathy with an Ejection Fraction of 25%).
Notch in the ascending limb of the R wave in lead aVL denotes
Chapman's sign.
Chapman's sign may also be seen in some patients with Dilated CardioMyoPathy and LBBB.





ECG 6a. The ECG above belongs to a 50 years-old diabetic man. He was complaining of fatique.
Left bundle branch block and isinus rhythm are evident. Leads I, aVL and V6 show
Chapman's sign.
To accomodate QRS complexes into a narrow paper format, the ECG computer depicted
right precordial leads at a calibration of 2.5 mm/mV and left precordial leads at a calibration of 5 mm/mV.

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ECG 6b.
Chapman's sign is seen in the compact format of ECG 6a (above).
All leads are presented at a calibration of 10 mm/mV.



   
Figures 6a and 6b. Coronary angiography was performed 15 minutes after record,ing of ECG 6a.
Three-vessel (extensive) coronary artery
disease was observed.
The figure on the left shows significant stenoses of the
LAD and Cx coronary arteries.
The figure on the right shows significant stenoses in the
right coronary artery.