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ECG-Q wave
This document contains a series of lectures from Professor Dr. Md Toufiqur Rahman on the topic of Q waves on electrocardiograms (ECGs). The professor defines a Q wave as any negative deflection preceding an R wave, representing normal left-to-right depolarization of the interventricular septum. Small, normal Q waves can be seen in specific left-sided leads. Larger or abnormal Q waves may indicate myocardial infarction or other conditions like cardiomyopathy. Examples of pathological Q waves and their associations with ST segments and T waves are shown from different leads.
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ECG-Q wave
- 1. MBBS, FCPS, MD,FACC, FESC, FRCP, FSCAI, FCCP,FAPSC, FAPSIC, FAHA,FACP,FASE Professor and Head of Cardiology Colonel Malek Medical College , Manikganj. For under-graduates drtoufiq19711@yahoo.com21/11/2019 Under graduate version 2019
- 2. drtoufiq1971@gmail.com 28.11.2019 CMMC-02 ECGLecture 09 Q wave Professor Dr Md Toufiqur Rahman The Q Wave âĸ A Q wave is any negative deflection that precedes an R wave âĸ The Q wave represents the normal left- to-right depolarisation of the interventricular septum âĸ Small âseptalâ Q waves are typically seen in the left-sided leads (I, aVL, V5 and V6)
- 3. drtoufiq1971@gmail.com 28.11.2019 CMMC-02 ECGLecture 08 Q wave Professor Dr Md Toufiqur Rahman
- 4. drtoufiq1971@gmail.com 28.11.2019 CMMC-02 ECGLecture 08 Q wave Professor Dr Md Toufiqur Rahman Q waves in different leads âĸ Small Q waves are normal in most leads âĸ Deeper Q waves (>2 mm) may be seen in leads III and aVR as a normal variant âĸ Under normal circumstances, Q waves are not seen in the right-sided leads (V1-3)
- 5. drtoufiq1971@gmail.com 28.11.2019 CMMC-02 ECGLecture 08 Q wave Professor Dr Md Toufiqur Rahman Pathological Q Waves Q waves are considered pathological if: > 40 ms (1 mm) wide > 2 mm deep > 25% of depth of QRS complex Seen in leads V1-3 Pathological Q waves usually indicate current or prior myocardial infarction.
- 6. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Differential Diagnosis/ Causes of Q waves âĸ Myocardial infarction âĸ Cardiomyopathies â Hypertrophic (HCM), infiltrative myocardial disease âĸ Rotation of the heart â Extreme clockwise or counter-clockwise rotation âĸ Lead placement errors â e.g. upper limb leads placed on lower limbs
- 7. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Loss of normal Q waves âĸ The absence of small septal Q waves in leads V5-6 should be considered abnormal. âĸ Absent Q waves in V5-6 is most commonly due to LBBB.
- 8. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Inferior Q waves (II, III, aVF) with ST elevation due to acute MI
- 9. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Inferior Q waves (II, III, aVF) with T-wave inversion due to previous MI
- 10. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Lateral Q waves (I, aVL) with ST elevation due to acute MI
- 11. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Anterior Q waves (V1-4) with ST elevation due to acute MI
- 12. drtoufiq1971@gmail.com 21.11.2019 CMMC-02 ECGLecture 07 Q wave Professor Dr Md Toufiqur Rahman Anterior Q waves (V1-4) with T-wave inversion due to recent MI