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ARTICLE |

Q-Wave vs Non—Q-Wave Myocardial Infarction: Title and subTitle BreakAn Oversimplified Dichotomy FREE

Arthur J. Moss, MD
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JAMA. 1992;268(12):1595-1596. doi:10.1001/jama.1992.03490120109037
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The diagnosis of myocardial infarction requires enzyme confirmation if we are to separate anginal syndromes from coronary disorders involving necrosis of myocardial tissue. Patients with a first myocardial infarction are more homogeneous in their risk profile and are more accurately categorized into different electrocardiographic subsets than are patients with prior infarctions. The electrocardiogram has been used to classify two types of myocardial infarction—the Q-wave (transmural) infarction, with the implication that a Q wave represents through-and-through endocardial-to-epicardial necrosis, and the non—Q-wave (nontransmural) infarction, with the implication that the absence of a Q wave indicates less extensive myocardial damage and possibly an increased potential for recurrent coronary events.

See also p 1545.

Non—Q-wave myocardial infarction is a heterogeneous group of disorders and includes true posterior transmural ("Q-wave") infarctions without manifest Q waves on the scalar 12-lead electrocardiogram, subendocardial infarctions with transient ST-wave and T-wave changes, intramural infarctions with giant negative T waves

REFERENCES

Spodick DH.  Q-wave infarction versus ST-infarction: nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol . 1983;;51:913-915.
Phibbs B.  'Transmural' versus 'subendocardial' myocardial infarction: an electrocardiographic myth. J Am Coll Cardiol . 1983;;1:561-564.
Benhorin J, Moss AJ, Oakes D, et al.  The prognostic significance of first myocardial infarction type (Q wave versus non-Q wave) and Q wave location. J Am Coll Cardiol . 1990;;15:1201-1207.
Gibson RS.  Non-Q-wave myocardial infarction: diagnosis, prognosis, and management. Curr Probl Cardiol . 1988;;13:1-72.
Berger CJ, Murabito JM, Evans JC, Anderson KM, Levy D.  Prognosis after first myocardial infarction: comparison of Q-wave and non—Q-wave myocardial infarction in the Framingham Heart Study. JAMA . 1992;;268:1545-1551.
Gibson RS, Boden WE, Theroux P, et al.  Diltiazem and reinfarction in patients with non-Q wave myocardial infarction. N Engl J Med . 1986;;315:423-429.
The Multicenter Diltiazem Postinfarction Trial Research Group.  The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med . 1988;;319:385-392.
Wong S, Greenberg H, Hager WD, Dwyer EM.  Effects of diltiazem on recurrent myocardial infarction in patients with non-Q wave myocardial infarction. J Am Coll Cardiol . 1992;;19:1421-1425.
Yusuf S, Peto R, Lewis J, Collins R, Sleight P.  Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis . 1985;;27:335-371.
Aspirin Myocardial Infarction Study Research Group.  A randomized, controlled trial of aspirin in persons recovered from myocardial infarction. JAMA . 1980;;243: 661-669.
Moss AJ, Benhorin J.  Prognosis and management after a first myocardial infarction. N Engl J Med . 1990;;322:743-753.

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Spodick DH.  Q-wave infarction versus ST-infarction: nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol . 1983;;51:913-915.
Phibbs B.  'Transmural' versus 'subendocardial' myocardial infarction: an electrocardiographic myth. J Am Coll Cardiol . 1983;;1:561-564.
Benhorin J, Moss AJ, Oakes D, et al.  The prognostic significance of first myocardial infarction type (Q wave versus non-Q wave) and Q wave location. J Am Coll Cardiol . 1990;;15:1201-1207.
Gibson RS.  Non-Q-wave myocardial infarction: diagnosis, prognosis, and management. Curr Probl Cardiol . 1988;;13:1-72.
Berger CJ, Murabito JM, Evans JC, Anderson KM, Levy D.  Prognosis after first myocardial infarction: comparison of Q-wave and non—Q-wave myocardial infarction in the Framingham Heart Study. JAMA . 1992;;268:1545-1551.
Gibson RS, Boden WE, Theroux P, et al.  Diltiazem and reinfarction in patients with non-Q wave myocardial infarction. N Engl J Med . 1986;;315:423-429.
The Multicenter Diltiazem Postinfarction Trial Research Group.  The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med . 1988;;319:385-392.
Wong S, Greenberg H, Hager WD, Dwyer EM.  Effects of diltiazem on recurrent myocardial infarction in patients with non-Q wave myocardial infarction. J Am Coll Cardiol . 1992;;19:1421-1425.
Yusuf S, Peto R, Lewis J, Collins R, Sleight P.  Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis . 1985;;27:335-371.
Aspirin Myocardial Infarction Study Research Group.  A randomized, controlled trial of aspirin in persons recovered from myocardial infarction. JAMA . 1980;;243: 661-669.
Moss AJ, Benhorin J.  Prognosis and management after a first myocardial infarction. N Engl J Med . 1990;;322:743-753.
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