![]() The ECG method of acuteness score was superior to historical timing in predicting myocardial salvage and prognosis after reperfusion therapy, suggesting that ECG-estimated duration of ischemia might provide a better and objective means to select acute reperfusion therapy rather than the subjective patient history, which could potentially preclude proper reperfusion in some patients with salvageable myocardium presenting late. However, the independent significance of the T-wave amplitude apart from the presence of Q waves has not been tested. This score is provided as a continuous scale from 4.0 (hyperacute) to 1.0 (subacute) based on the comparative hyperacute T waves versus abnormal Q waves in each of the leads with ST elevation. When the infarct-related artery (right coronary or left circumflex artery) is very dominant and the occlusion is proximal, the infarction encompasses both the inferior and the lateral wall, and then the ECG pattern is the association of criteria of inferior and lateral MI (inferolateral MI).Īnderson-Wilkins and colleagues developed an ECG acuteness score to augment historical timing of the acute symptom onset or, alternatively, to estimate viability. Finally, inferior MIs produce Q waves in leads II, III, and aVF, but without increased R waves in leads V1 and V2. There may also be abnormal Q waves in lead I, aVL, and/or V5 and V6. ![]() In lateral MI, the ECG may produce the Q-wave equivalents of abnormally prominent R waves in leads V1 and V2. Consequently, the ECG shows abnormal Q waves in the precordial leads and lead aVL (sometimes also in lead I). E xtensive anterior infarction is essentially a combination of the three previously mentioned types. There are no abnormal Q waves in leads aVL and I. Compared with septal infarction, in apical-anterior MI, the abnormal Q waves extend into the more leftward precordial leads – typically V3 and V4 and sometimes V5 and V6. This MI subtype is typically caused by occlusion of the first diagonal branch, and in the ECG Q waves are present in leads aVL (I) and sometimes V2. ![]() The term mid-anterior was recommended for MIs located especially in the mid-low segments of the anterior wall. In septal MI, the septal wall and often a small part of the adjacent anterior wall are involved, and the ECG shows Q waves in leads V1 and V2. The consensus group recommended to classify the different MI locations based on the following six most commonly occurring patterns of abnormal Q waves and Q-wave equivalents (Fig. Based on these findings, a new terminology for LV walls and location of Q-wave MIs was proposed. More recently, the correlation between Q waves in various ECG leads and the affected myocardium has been studied by CMR.
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