Intermittent Noninfarction Q Waves: A Finding Suggestive of Latent Preexcitation

Letts, Dustin P.; Constantine, Jeffrey C.; Littmann, Laszlo
July 2003
Mayo Clinic Proceedings;Jul2003, Vol. 78 Issue 7, p840
Academic Journal
• Objective: To describe 3 patients who presented with chest pain and intermittent Q waves on the electrocardiogram (ECG) and were subsequently found to have latent preexcitation. • Patients and Methods: During a span of 8 years, 3 patients were evaluated because of atypical chest pain and pathologic Q waves in the inferior leads; in all 3 patients, the Q waves were intermittent. No patient had a history of arrhythmia or had Wolff-Parkinson-White pattern on the ECG. Diagnostic and therapeutic interventions for suspected myocardial infarction included cardiac catheterization in 2 patients, intravenous thrombolytic therapy in 1 patient, and heparin in 2 patients. Ischemic heart disease was excluded in all. Patients underwent pharmacological testing and/or electrophysiologic study for suspected preexcitation. • Results: Despite the absence of ECG markers of preexcitation, the presence of a latent accessory atrioventricular connection was confirmed in each patient by pharmacological or electrophysiologic studies. • Conclusion: In patients who present with intermittent noninfarction Q waves, the most likely diagnosis is latent preexcitation. Clinicians need to be educated about this clinical diagnosis and encouraged to pursue confirmatory testing. Such patients should be informed about the nature and importance of their electrocardiographic abnormality.


Related Articles

  • ECG of the month. Regan, Claire; Regan, Martin // British Journal of Cardiac Nursing;Nov2014, Vol. 9 Issue 11, p527 

    The article presents questions and answers related to electrocardiogram of a primary percutaneous coronary intervention patient referred by the emergency department.

  • Country cardiograms case 51. Slatnik, Michael // Canadian Journal of Rural Medicine;Summer2014, Vol. 19 Issue 3, p107 

    The article describes the case of a 54-year-old man who was presented to the emergency department due to chest pain. Vital signs were recorded. During his check-in, he was unresponsive, and a code blue is called. In order to revive him, a prompt intravenous fluid resuscitation and supplementary...

  • Country cardiograms case 48. Helm, Charles // Canadian Journal of Rural Medicine;Summer2013, Vol. 18 Issue 3, p99 

    A quiz based on the electrocardiogram of a 50 year old man with excruciating chest pain who was brought to the emergency department of a hospital in a remote Canadian community is presented.

  • ECG of the month. Regan, Martin // British Journal of Cardiac Nursing;Nov2015, Vol. 10 Issue 11, p527 

    The article presents a medical quiz about an electrocardiogram (ECG) of a 52-year-old male who was pale, clammy and complaining of central chest pain after having collapsed at work.

  • ECG of the month. Regan, Claire; Regan, Martin // British Journal of Cardiac Nursing;Oct2012, Vol. 7 Issue 10, p482 

    A clinical image of an electrocardiogram (ECG) demonstrating ST elevation in leads II, III, AVF and V1 to V4 and ischaemic, in a 56-year-old male with central chest pain, is presented.

  • Blood test may predict heart attack.  // Las Vegas Business Press;07/27/98, Vol. 15 Issue 30, Health Scene p2 

    Reports on a blood test that may reveal which people with chest pain are at highest risk of heart attack.

  • Two approaches to emergency department evaluations of chest pain.  // Modern Medicine;Apr95, Vol. 63 Issue 4, p54 

    Presents an abstract of the editorial `Evaluation of chest pain in the emergency department,' by S. Kaul and R.D. Abbott from the December 15, 1994 issue of the journal `Annals of Internal Medicine.'

  • Country cardiograms case 36. Helm, Charles // Canadian Journal of Rural Medicine;Spring2010, Vol. 15 Issue 2, p68 

    The article presents a case study of a 52-year-old man who presented to an emergency department with chest pain. An electrocardiogram (ECG) was obtained and thrombolytic therapy was initiated. The article discusses the interpretation of the patient's ECG, which indicates a diagnosis of ST...

  • Dramatically cut delays in review of an EKG.  // ED Nursing;Nov2010, Vol. 14 Issue 1, p7 

    The article reports on techniques to cut delays in reviewing an electrocardiogram (EKG) in the U.S. It cites the case at Huntsville Hospital where EKG is done immediately but still needs to be reviewed by the emergency department (ED) physicians within five minutes. It cites several strategies...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics