Repeat ECG was done 3 hours later showing Q-waves
developing in V2-4, consistent with the final stages of acute STEMI accompanied with ST-segment elevation in lead V2-4 which barely meets the 2 mm threshold for those precordial leads as per the guidelines (Figure 2).
The universal definition of myocardial infarction is increased troponin concentration (>99th percentile of the upper reference range), together with at least 1 of the following: symptoms of ischemia, ECG changes of new ischemia, development of pathological Q-waves
on ECG, or imaging evidence of new loss of viable myocardium and new regional wall motion abnormalities (8, 9).
ST segment elevation in precordial leads along with ST segment depression of >1 mm in inferior leads II, III, aVF was noticed among 155 (77.5%) patients; abnormal Q-waves
of width >30 ms in lead aVL among 69 (34.5%) patients and ST segment elevation of >3-5 mm in lead I and aVL was seen among 82 (42%) patients (table-III).
EKG changes are seen in 75% to 95% of affected patients and include the presence of Q-waves
and increased voltages related to LVH.
Variables extracted from surface ECGs, such as abnormal Q-waves
, and intraventricular electrical transients in the SAECG, correlate with myocardial fibrosis and conduction abnormalities (7,8).
The electrocardiogram revealed only the Wolf-Parkinson-White syndrome: the delta wave was hiding the Q-waves
because the conduction was via the accessory pathway, as Brackbill et al.
HCM patients usually demonstrate a combination of T-wave inversion not including V1, III and aVR, ST-segment depression, left bundle branch block, left axis deviation, pathological Q-waves
, left atrial enlargement and voltage criterion for left ventricular hypertrophy).
Characteristic biphasic T-wave changes in precordial leads without Q-waves
in a pain-free period is called Wellens' syndrome and is associated with severe proximal LAD stenosis.
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Wireless Data Kit provides the following exclusive features:
"The problem is, not all UMIs result in Q-waves
on the electrocardiogram.
Alterations called Q-waves
indicate that a heart attack previously occurred.