QS COMPLEX IN ELECTROCARDIOGRAM LEADS V1-V3 - MYOCARDIAL-INFARCTION OR OTHER CAUSE - A CLINICOPATHOLOGICAL STUDY OF AUTOPSIED ELDERLY INPATIENTS

Background: Abnormal QS complexes in the right precordial leads are on e of the most useful electrocardiographic signals in the diagnosis of anteroseptal myocardial infarction. Their presence is also attributabl e to other causes, however. Our aim was to assess the relative prevale nce of different causes of abnormal QS complexes in elderly patients. Methods: Clinical, electrocardiographic and anatomopathological data w ere collected from 36 autopsied in-patients who had presented with a Q S complex in leads V1-V3 on admission to hospital. Results: Twenty-one patients (58%) had no evidence of old myocardial infarcts on postmort em histological examination. In eight of these patients, the abnormal QS complex could be attributed to infiltrative or congestive cardiomyo pathies, and in eight others to hypertrophic cardiomyopathy associated with aortic valve stenosis or hypertension. Three individuals had onl y altered ventricular activation; in two of these patients, the abnorm al QS complexes were positional in origin. Conclusion: The presence of a QS complex in the right precordial leads of the electrocardiogram i s important in the diagnosis of anteroseptal infarction. However, abno rmal QS complexes may also result from a wide spectrum of other diseas e states. Faced with abnormal QS complexes on the electrocardiogram, t he clinician should make sure that echocardiographic features of left ventricular function are outside normal limits before suspecting anter oseptal necrosis.