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New Q waves do not always a new infarct spell: right bundle branch block-dependent Q waves simulating infarct
Coronary Artery Disease
|May 20, 1998
Summary
Right bundle branch block in acute anterior wall infarction can create new Q waves in V1-V2. This mimics necrosis extension but is a known phenomenon impacting reperfusion strategies.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Acute anterior wall myocardial infarction is a critical cardiac event.
- Right bundle branch block (RBBB) is a common electrocardiographic finding.
Observation:
- Electrocardiograms (ECGs) of 14 patients with acute anterior wall infarction and RBBB were analyzed.
- A specific pattern of depolarization shift was noted in these patients.
Findings:
- The appearance of RBBB in acute anterior wall infarction was associated with a shift in the initial depolarization vector.
- This shift resulted in 'new' Q waves in leads V1-V2.
- These Q waves mimicked the extension of myocardial necrosis.
Implications:
- This electrocardiographic phenomenon is not widely recognized.
- Clinicians should be aware of this finding when evaluating acute anterior wall infarction.
- Consideration of this phenomenon is crucial for guiding reperfusion therapy decisions.