Observation of q or Q waves in precordial leads (C1-C6) suggest the diagnosis of

     
OLD anterior myocardial infarction.

  Usually,
negative T waves accompany the q waves.

 
Loss of R wave progression in chest leads is also frequently observed.

  Anterior myocardial infarction is NOT ACUTE when precordial leads (C1-C6) show
q or Q waves,

      but lack ST segment elevation or hyperacute T waves.

  Some patients develope left ventricular aneurysm after the acute phase of infarction.

Click here for Left Ventricular Aneurysm





ECG 1. Old anterior wall myocardial infarction. Leads C1 to C4 show QS waves.
Lacking of ST segment elevation despite the presence of negative T waves suggests OLD anterior myocardial infarction.

Click here for a more detailed ECG





ECG 2. Old anterior wall myocardial infarction.
Precordial leads show loss of R wave progression with deep, symmetrically negative T waves.

Click here for a more detailed ECG





ECG 3. Old anteroseptal myocardial infarction is seen in the above ECG: Leads C1 to C3 show QS pattern
with mild ST segment elevation and negative T waves. T wave negativity extend to leads V4 and V5.

Click here for a more detailed ECG





ECG 4. T wave negativity is NOT a necessity in diagnosing old anterior wall myocardial infarction.
The ECG above is from a patient who had experienced acute anterior myocardial infarction two years ago.
He has apical left ventricular aneurysm. Q waves in leads C1 to C6 show old anterior myocardial infarction.
Leads C1 to C4 show ST segment elevation, which is a frequent finding when aneurysm develops.
Persistence of ST segment elevation weeks after myocardial infarction does NOT show acute ischemia.

Click here for a more detailed ECG





ECG 5. The above ECG is from a 76 years-old man with coronary artery disease.
He had experienced acute anterior myocardial infarction 12 years ago and refused coronary artery bypass graft surgery.
Now, he has significant left ventricular systolic dysfunction and all of his cardiac chambers are dilated.
The rhythm is atrial fibrillation. The presence of right bundle branch block (RBBB) does not obscure
the diagnosis of old anterior myocardial infarction.
Precordial leads show Q waves and leads V5 and V6 show ST segment elevation .

Click here for a more detailed ECG





ECG 6. The ECG above is from a 65 years-old man who had undergone coronary artery bypass graft surgery.
He had experienced acute anterior wall myocardial infarction before the surgery.
Now, he has left ventricular systolic dysfunction.
Q waves are seen in leads C1 and C2 .
The presence of RBBB does not obscure the diagnosis of old anterior wall myocardial infarction.

Click here for a more detailed ECG





ECG 7. The above ECG belongs to a 63 years-old man.
It was recorded when he was experiencing his second anterior myocardial infarction (reinfarction).
RBBB had developed during his first acute anterior myocardial infarction, two months ago.
He had developed left ventricular systolic dysfunction with an Ejection Fraction of 35%.
In the last two months, he already had
Q waves in leads C1 to C4.
While experiencing his re-infarction,
re-elevation of ST segment in leads C2 to C4 was observed.
The presence of RBBB does not obscure the diagnosis of acute anterior wall myocardial infarction.

Click here for a more detailed ECG





ECG 8. The ECG above belongs to a 63 years-old man who had undergone coronary artery bypass graft surgery.
He had experienced acute anterior wall myocardial infarction before the surgery.
Now, he has left ventricular systolic dysfunction with an Ejection Fraction of 30%.
Q waves in leads C1 to C3 , negative T waves in leads C4 to C6 and a VPC are seen.
The presence of RBBB does not obscure the diagnosis of old anterior wall myocardial infarction.

Click here for a more detailed ECG





ECG 9. The ECG above is from a 60 years-old woman who had experienced acute anterior wall myocardial infarction.
She has severe left ventricular systolic dysfunction with an Ejection Fraction of 20%.
Precordial leads show
Q waves and negative T waves . RBBB is also seen.
The presence of RBBB does not obscure the diagnosis of old anterior wall myocardial infarction.

Click here for a more detailed ECG





ECG 10. The above ECG is from a 42 years-old man who had experienced acute anterior myocardial infarction 6 weeks ago.
Coronary angiography showed total occlusion of the proximal LAD. His Cx and RCA coronary arteries were normal.
He had undergone PTCA and stenting of the LAD.

Click here for a more detailed ECG





ECG 11. The above ECG is from a 55 years-old man who had experienced acute anterior myocardial infarction two months ago.
Baseline drift especially involves the precordial leads.
The unaffected
first precordial QRS complex shows old anterior myocardial infarction.

Click here for a more detailed ECG





ECG 12a. The above ECG is from a 62 years-old woman who had experienced acute anterior myocardial infarction 4 years ago.
Right bundle branch block (RBBB) and left anterior fasciclar block is seen.
ST segment elevation in leads V3 to V5 is present for a long time, suggesting left ventricular (LV) aneurysm.
Her ECHOcardiography showed aneurysm of the interventricular septum and LV apex.
She had LV and left atrial dilation with an LV ejection fraction of 28% (systolic dysfunction).

Click here for a more detailed ECG




ECG 12b. Above is her ECG which was recorded 18 months ago.
ST segment elevation in leads V3 to V5 was present 18 months ago.
Persistent ST segment elevation usually suggests the presence of left ventricular aneurysm.

Click here for a more detailed ECG





ECG 13. The ECG above is from an 89 years-old man who had experienced acute anterior myocardial infarction twice.
ECHOcardiography showed a very depressed left ventricle with an ejection fraction of about 15%, apical aneurysm and
mural thrombus. Anterior leads show Q waves and domed ST segment elevation.
Leads V4 to V6 also show negative T waves.
Lead aVR shows prominent R waves (Goldberger sign).
Leads II and III also show interatrial block.

Click here for a more detailed ECG





ECG 14. The ECG above belongs to a 41 years-old man with old anterior wall myocardial infarction.
Leads V3 and V4 show fragmented QRS. No typical ST segment elevation is seen.
ECHOcardiography showed apical LVA in this patient.
Absence of typical ECG findings do not exclude the possibility of a LVA.

Click here for a more detailed ECG





ECG 15.The compact ECG above belongs to a 66 years-old man with old anterior myocardial infarction.
ECHOcardiography showed apical LVA.
Leads V2 to V6 show domed ST elevation. Leads V3 to V6 also show negative T waves.
Fragmented QRS complexes in leads V4 to V6 suggest the presence of LVA.





ECG 16. The ECG above belongs to a 75 years-old woman who had experienced acute anterior myocardial infarction 8 years ago.
ECHOcardiography showed apical aneurysm.
Precordial leads show Q waves and ST segment elevation.
Fragmented QRS complexes, Goldberger sign and negative T waves are not seen in the above ECG.

Click here for a more detailed ECG





ECG 17. The ECG above belongs to a 59 years-old man who had experienced anterior wall myocardial infarction 7 years ago.
A recent ECHOcardiography examination showed aneurysm of the left ventricular apex and anterior septum.
Only the septal leads (V1 and V2) show ST segment elevation. Leads V2 to V6 show negative T waves.

Click here for a more detailed ECG





ECG 18. The ECG above belongs to a 49 years-old man with old anterior wall myocardial infarction.
Precordial leads show Q waves, ST elevation and negative T waves.
ECHOcardiography showed a large apical LVA.
Left ventricular systolic dysfunction was depressed and the ejection fraction was about 30%.

Click here for a more detailed ECG





ECG 19. The ECG above belongs to a 69 years-old man with old anterior wall myocardial infarction.
His LAD and Cx coronary arteries were stented at the time of the acute infarction.
ECHOcardiography showed a large apical LVA with an Ejection Fraction of 25%.
Leads V1 to V3 show Q waves and
ST segment elevation.
Some precordial leads also show negative T waves.

Click here for a more detailed ECG





ECG 20. The ECG above belongs to a 65 years-old man with old anterior wall myocardial infarction.
Leads C1 to C3 show ST segment elevation.
Leads C2 to C4 show fragmented QRS complexes.
ECHOcardiography showed apical LVA in this patient.

Click here for a more detailed ECG





ECG 21. The ECG above belongs to a 59 years-old man with old anterior myocardial infarction (12 years ago).
ECHOcardiography showed aneurysm of the anterior wall and the interventricular septum.
Intraventricular conduction defect is seen.
Domed ST elevation and fragmented QRS complexes are seen. The VPC also shows fragmentation.

Click here for a more detailed ECG





ECG 22. The ECG above belongs to a 70 years-old woman with old anterior wall myocardial infarction.
She had undergone coronary artery bypass graft operation for the LAD and Cx coronary arteries.
A recent ECHOcardiography examination showed apical aneurysm with an Ejection Fraction of about 40%.
Precordial leads show Q waves, leads V1 to V3 show
domed ST elevation and negative T waves.
Lead V3 also shows
fragmented QRS complexes.

Click here for a more detailed ECG





ECG 23. The ECG above belongs to a 43 years-old man with old anterior wall myocardial infarction.
Precordial leads V4 to V6 show Q waves while leads V1 to V4 show domed ST elevation.
Leads V2 to V6 show negative T waves.
Leads V3 and V4 also show fragmented QRS complexes. rSr' pattern is seen in lead V3.
ECHOcardiography showed a large apical aneurysm and a left ventricular Ejection Fraction of about 30%.

Click here for a more detailed ECG





ECG 24. The ECG above belongs to a 61 years-old woman with old anterior wall myocardial infarction.
Her LAD artery was stented at the time of acute infarction.
Precordial leads V1 and V2 show Q waves while leads V1 to V3 show domed ST elevation and negative T waves.
ECHOcardiography showed apical aneurysm and a left ventricular Ejection Fraction of about 40%.

Click here for a more detailed ECG





ECG 25. The ECG above belongs to a 58 years-old man with old anterior wall myocardial infarction.
He had come to the hospital 6 hours after the onset of myocardial infarction.
The Left Anterior Descending (LAD) coronary artery was totally occluded at its ostium.
He also had significant stenosis of the first Obtuse Marginal branch of the Circumflex coronary artery.
Ten months after the infarction, he now has a large left ventricular (LV) apical aneurysm with an Ejection Fraction of about 15%.
His ECG does not show typical ST segment elevation or QRS fragmentation, despite the presence of a large LV aneurysm.
Goldberger sign and evidence of left atrial abnormality are seen.

Click here for a more detailed ECG





ECG 26. The ECG above is from a 75 years-old man. QT interval prolongation and old anterior myocardial infarction are seen.

Click here for a more detailed ECG





ECG 27a. The ECG above is from a 68 years-old woman with coronary artery disease.
QS waves are clearly seen in leads V1 and V2.
Subtle q waves are seen in leads V3 and V4.
No T wave negativity is seen in leads V2 to V6. Chest leads also lack persistent ST segment elevation.
This is a relatively uncommon pattern of old anterior myocardial infarction.
She had experienced acute anterior wall myocardial infarction two years ago.
ECHOcardiography showed hypokinesia of the middle segments of the interventricular septum and anterior septum.
Left ventricular ejection fraction was calculated as 45% (mild systolic dysfunction).
Additionally, narrow QRS complexes are seen in her ECG (QRS width is 72 milliseconds).

Click here for a more detailed ECG




ECG 27b. The compact ECG above belongs to the same patient. It is derived from ECG 27a.





ECG 28a. Above ECG is from a 63 years-old man who had experienced acute anterior myocardial infarction 2 days ago.
Leads V1 and V2 show prominent Q waves.
Lead V3 shows subtle q waves.
Leads V3-V6 show neither deeply negative T waves nor persistent ST segment elevation.
ST segment depression is seen in leads I,aVL, V5 and V6.
The last precordial beat is a VPC.
Coronary angiography showed 3-vessel disease (extensive coronary artery disease).
Anterior septum was severely hypokinetic during ECHOcardiography.
Left ventricular ejection fraction was calculated as 42% (mild systolic dysfunction).
This ECG was recorded before his coronary artery bypass surgery.

Click here for a more detailed ECG




ECG 28b. The compact ECG above belongs to the same patient. It is derived from ECG 28a.





ECG 29a. Above ECG is from a 56 years-old man who had experienced acute anterior myocardial infarction 4 years ago.
Leads V1 and V2 show prominent Q waves.
Lead V3 shows subtle q waves.
Leads V3-V6 show persistent ST segment elevation but lack negative T waves.
Interatrial block is also seen (P wave width in leads II and III are above 120 milliseconds).
The sinus tachycardia is due to his anxiety during recording of the ECG.
His proximal LAD artery had been stented 4 years ago.
ECHOcardiographically, her left ventricular ejection fraction was 40% (mild systolic dysfunction).

Click here for a more detailed ECG




ECG 29b. The compact ECG above belongs to the same patient. It is derived from ECG 28a.





ECG 30. Above ECG is from a 71 years-old man who had experienced acute septal myocardial infarction in the past.
QS complexes are seen in leads V1 and V2.
Leads V1 to V3 show persistent ST segment elevation.
The rhythm is atrial fibrillation.
ECHOcardiographically, his left ventricular ejection fraction was 25% (severe systolic dysfunction).

Click here for a more detailed ECG





ECG 31. Above is an ECG from a 56 years-old man who had experienced acute anterior myocardial infarction one week ago.
His left ventricular systolic function was mildly affected (anterior septum was hypokinetic).
ECHOcardiography showed left ventricular ejection fraction (EF) as 50%.

Click here for a more detailed ECG