00:01
So, as the myocardial infarct heals, the EKG develops these initial Q waves
and usually they stay there.
00:09
Even years later, the Q waves may tell us, “Oh, there was an earlier myocardial infarct in this zone.”
Let's say there were Q waves in 2, 3, and aVF and the patient said,
“Oh, yes, I had a heart attack 10 years ago.”
Those Q waves are still there because there's a scar there.
00:24
There's an electrically quiet zone in the scar that shows the infarct that occurred in the past.
00:31
So with time, the ST elevation comes down.
00:35
It becomes flat again. Usually the T waves then become inverted
and as I mentioned, Q waves can persist as a permanent reminder of the old MI
and then over time, the inverted T waves usually become upright again.
00:49
So here, how do we know abnormal Q waves?
Well first of all, abnormal Q waves are usually going to be less than one little box.
00:59
So less than 0.04 seconds and less than 2 mm in depth.
01:04
So that means there gonna be less than 1 small box wide and less than 2 small boxes deep.
01:13
And here we see an old EKG.
01:15
This is an old inferior MI. Do you see leads 2, 3, and aVF?
There are very significant Q waves there wider than 1 little box
and particularly in leads 3 and aVF, they're deeper than 2 little boxes.
01:30
So previous inferior MI.
01:32
Also notice here that the T waves are inverted.
01:35
They haven't come back yet.
01:36
Usually with time they will come back.
01:39
So larger Q waves are pathological Q waves.
01:43
They're usually sign of a prior MI and as I said in this EKG, 2, 3, and aVF show an old inferior MI.
01:51
Another example: here we see, again, Q waves.
01:55
It leads 2, 3, and aVF. This is an old inferior MI.
01:59
Notice the green boxes showing you the Q waves.
02:02
There are abnormally inverted T waves there as well.
02:06
And also notice inverted T waves out in V3, 4, 5, and 6
so this tells you that there's some lateral anterior involvement.
02:15
This may very well be a circumflex infarct.
02:19
Cuz circumflex can give you both supply to the posterior wall and also to the lateral wall.
02:27
Q waves in these leads imply that the MI was not just on the back of the heart
but also involved possibly some of the anterior and lateral wall.
02:37
Here's another example: here's a Q wave in leads V1, V2, V3. Notice the green boxes.
02:44
There's a small residual amount of ST elevation in these leads
so this infarct may have been within the last few weeks or days
and there's also inverted T waves in the rest of the anterior leads.
02:59
Again, telling you this is an anterior wall myocardial infarct.
03:04
The computer frequently will read these findings as anterior infarct age indeterminate.
03:11
We don't know when it exactly occurred. It's not acute. It's not just occurring right now.
03:16
It occurred at some point in the past.