9/25/2023 0 Comments Abnormal q wave v1 and v2![]() 20 (yes, 20) in the past 6 months! Almost every hospital in the area had records of him presenting with chest pains not relieved with nitroglycerin, and then relieved with IV morphine. Actually, this was coronary angiogram No. So, why a left groin hematoma?Ī little investigating was done and we found out he DID have a prior history. I was pretty sure right femoral artery access - not left - was used. ![]() A couple of hours after the angiogram I was called to check on him due to left groin pain. He remained chest-pain-free and his cardiac enzymes remained normal throughout the hospitalization. The term "Q-wave MI" is an old term that used to refer to "transmural" infarctions resulting in Q waves in the ECG. An old anterior MI would have pathologic Q waves in the anterior precordial leads (V1-V3) and an old inferior MI in the inferior leads (II, III and aVF).įrequently we revascularize acute ST elevation MIs quite quickly and Q waves don't develop. ![]() They call this "Tombstoning" since the combination of the ST segment and the T wave look like a tombstone:Įventually the ST elevation resolves and, if the infarct completes, a "pathologic" Q wave develops like in our patient's ECG. Here is a picture of an acute anterior ST elevation MI with 5 mm of ST elevation at the J point. The second change is ST segment elevation at the J point. Here is an example of hyperacute T waves: Hyperacute T wave changes are the first ECG change during acute MI and are quite transient, so usually missed. Let's review the ECG in an acute MI briefly Here is a comparison of normal Q waves in the inferior leads compared with pathologic Q waves: They take at least a few hours, to a couple of days after an MI, to develop and can persist for a lifetime in many cases, especially if coronary revascularization is not performed quickly. These Q waves take some time to develop and would NOT be present within 20 minutes of symptom onset. What does "pathological" mean? This means a certain disease process is present, specifically myocardial infarction. more than 25% of the total QRS complex amplitude and.We consider a Q wave pathologic (abnormal) when: It is normal to have small Q waves in most leads. The Q wave is the first downward deflection of the QRS complex that occurs before the R wave. Notice those Q waves in the anteroseptal leads V1-V3? That is NOT consistent with acute chest pain for 20 minutes! More like an old anterior MI. No acute LAD thrombus here, like the clinical picture might suggest. chronically totally occluded, consistent with an old remote MI. A coronary angiogram shows that his right coronary and circumflex coronary arteries were normal. The cath lab is activated for an anterior ST elevation MI. The ECG shows a little anterior ST elevation. His clinical picture sounds typical for acute MI, right? A little too typical.
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