Electrocardiography and Vectorcardiography in Idiopathic Hypertrophic Subaortic Stenosis

Extent of Myocardial Hyperenhancement on Late Gadolinium-Enhanced Cardiovascular Magnetic Resonance Correlates with Q Waves in Hypertrophic Cardiomyopathy

“…In a further study, Lemery et al (4) found a relationship between the presence of abnormal Q waves and an increased ratio of basal ventricular septal thickness to either right ventricular wall thickness or posterior LV wall thickness. Other investigators have suggested that Q waves are due to myocardial fibrosis, a common finding in the left ventricular wall of patients with HCM studied at necropsy (5,6).…”

“…However, no clear correlation between the severity of ventricular hypertrophy and the presence of Q waves could be demonstrated in previous studies (3,15,16). Other investigators support the viewpoint of previous pathologic studies that Q waves may result from myocardial scarring, a common finding in patients with HCM (5,6). In this context, Koga et al (17) recently demonstrated that loss of electrical forces due to transmural myocardial fibrosis and altered direction of the initial QRS vector due to increased electrical forces of a disproportionately hypertrophied basal septum and/or left ventricular free wall, unopposed by apical forces, are possible mechanisms of abnormal Q waves in HCM.…”

“…Despite several electrocardiographic (3,9,11,15), echocardiographic (3,15), electrophysiologic (7,8) and pathologic studies (13,14) the underlying mechanisms of abnormal Q waves in HCM are not yet completely understood. Generally, it has been suggested that Q waves in HCM result from disturbed electrical activation and depolarization of the hypertrophied ventricular septum (5,7,8,13,14). However, no clear correlation between the severity of ventricular hypertrophy and the presence of Q waves could be demonstrated in previous studies (3,15,16).…”

“…Patients with hypertrophic cardiomyopathy (HCM) present with various electrocardiographic (ECG) abnormalities, including increased QRS voltage, T wave changes and pathologic Q waves (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Although no single ECG pattern is characteristic, abnormal Q waves are one of the most common abnormalities in HCM and can mimic myocardial infarction (5,(12)(13)(14).…”

“…Although no single ECG pattern is characteristic, abnormal Q waves are one of the most common abnormalities in HCM and can mimic myocardial infarction (5,(12)(13)(14). Despite several electrocardiographic (3,9,11,15), echocardiographic (3,15), electrophysiologic (7,8) and pathologic studies (13,14) the underlying mechanisms of abnormal Q waves in HCM are not yet completely understood.…”