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: 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