When anterior epicardial fat . . . generates Q waves . . . diagnosis of ASMI gets busted !
Q wave are neither sacred nor sinister waves . It represents either of the following .
Electrical activity that goes away from the recording electrode.
Or whenever there is a electrical insulation or hurdle that interrupts the flow of current towards the electrode ( and if it is sustained ) it can result in q waves (Minor interruption produces a notch or slurs . Please note a major slur becomes a q wave equivalent )
Here is young women of 42 years with a diagnosis of old anterior MI for over 5 years ( Getting a dedicated care from a cardiologist! The prescription included Imdur/Betaloc/ Statin/Clopidogrel and Aspirin )
This was the ECG . It was very convincing for old ASMI.
It happened , I did an echo for her .
She lacked wall motion defects even after a meticulous search . Instead she had a good layer of epicardial fat measuring 9 mm .That was more localised in anterior wall extending little to LV apex.Her EF 65 % .
*She was a fairly obese (not gross ) individual with a BMI of 34 .The fat pad thickness was not that huge , I thought , still it was producing the q waves . I have seen much thicker fat pads with good R waves in ECG . I wonder , is it the type of fat that adds up to electrical insulation ?
This patient was sent back to me again for ruling out ASMI . It was not there .
What is the normal thickness of epicardial fat pad ?
It is less than few mm . Exact normality is not known .(Empiricall...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: drsvenkatesan Tags: Cardiology - Electrophysiology -Pacemaker cardiology -ECG Cardiology -unresolved questions Clinical cardiology epicardial fat and q waves non infarct q waves pesdo infarct patterns in ecg Source Type: blogs
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