With all those Q-waves, this can ' t be acute OMI, right?

Author ' s note: This post is guest-written byBrooks Walsh, an emergency physician with an interest in emergency electrocardiology and echocardiography, along with Steve Smith. I ' m grateful for Steve ' s review and additional comments.The case is not recent, and non-relevant details have been changed to make this case unidentifiable.The case: A week of chest painAn older gentleman was brought to the ED, complaining of burning abdominal pain. The pain had started about a week ago, but had worsened the day he came to the ED.An ECG was obtained:The ST elevation in the inferior leads does not clearly meet standard STEMI criteria. The ST elevation in the inferior leads is modest, and< 1 mm even in lead III. Of course, there is reciprocal ST depression in aVL, which validates a diagnosis of an Occlusion MI, an “OMI.” But there are also fairly overt Q waves in the inferior leads - see aVF for example:But a skeptical team member pointed out those inferior Q waves in the inferior leads, suggesting that angiography wouldn ' t be worth it: To paraphrase them:“The ECG is Q ’ed out,this is an old infarct. ”So: Should urgent angiography be canceled?Smith Answer: No!  Presence of Q-waves is common in acute OMI.  When there are QS-waves (not QR-waves!!) in the precordial leads, then old MI is possible.  In such cases, use the LV aneurysm.  See explanation here: Chest pain and ST Elevation.  Inferior OMI is much more difficult to dif...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs