ECG library
Old inferior infarction
coreA pre-operative ECG in a 71-year-old who 'has never had heart trouble'. The inferior leads disagree.
25 mm/s · 10 mm/mV · synthetic tracing
100%
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.
Key findings
- Pathological Q waves confined to the inferior territory
- No ST elevation or reciprocal depression: the event is history, not news
Learning points
- Q waves are scars: electrically silent muscle letting the opposite wall's forces show through. They date an infarct as old, not ongoing.
- A 'silent' infarct on a routine ECG rewrites the risk assessment: this patient has coronary disease whether or not anyone diagnosed it.
- Pathological versus positional Q: depth over a quarter of the R, width over 40 ms, and contiguous-territory company.
Connected