Absent septal q wave on electrocardiogram: a forgotten marker of myocardial disease
1Cardiac Department, Royal Brompton Hospital, London, UK.
Insights
Absence of the septal q wave on an electrocardiogram (ECG) is common in coronary artery disease patients. This finding indicates septal fibrosis and impaired left ventricular function, suggesting its use as a marker for ventricular disease.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- The septal q wave's absence on standard ECGs, noted by Willem Einthoven, is underrecognized.
- This ECG abnormality is prevalent in patients with coronary artery disease.
Purpose of the Study:
- To highlight the significance of the absent septal q wave as a potential noninvasive marker for ventricular disease.
- To investigate the association between absent septal q waves and cardiac structure and function.
Main Methods:
- Analysis of standard electrocardiograms (ECGs) to identify the absence of septal q waves.
- Correlation of ECG findings with cardiac conditions, specifically coronary artery disease and septal fibrosis.
- Evaluation of the impact on left ventricular systolic and diastolic function.
Main Results:
- Absence of the septal q wave is strongly associated with septal fibrosis, with or without infarction.
- This ECG finding correlates with disturbed ventricular activation.
- Impaired systolic and diastolic left ventricular performance is linked to this abnormality.
Conclusions:
- The absence of the septal q wave is a significant, easily detectable, noninvasive marker of ventricular disease.
- Wider recognition of this sign is recommended due to its structural, functional, and prognostic implications.
- It serves as an indicator of septal fibrosis and impaired ventricular mechanics in coronary artery disease.
Abstract:
Though absence of the septal q wave on a standard ECG was recognised by Willem Einthoven, this abnormality has received little attention. Nevertheless it is common in patients with coronary artery disease, and strongly associated with fibrosis of the septum with or without infarction. Furthermore, the associated disturbance of ventricular activation has clear mechanical consequences, impairing both systolic and diastolic left ventricular performance. Its structural, functional, and possible prognostic significance combined with ease of its detection all suggest that the cardiographic sign of absence of the septal q wave should be more widely recognised as a noninvasive marker of ventricular disease.
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