LVH is a common ECG finding .Classically it should produce tall R waves and deep S waves in V1-V3 .
But it is well known deep q waves also can occur in LVH especially in severe forms of pathological LVH.
Why the septal R disappears in some is not clear .( due to myocardial dis-array ? )
LVH results in secondary ST /T changes either inherent or associated conduction delay. (In-complete LBBB )
Errors mistaking LVH for STEMI is more common than we realise . Propagation of the term Q -LVH with ST elevation will help reduce this common error in coronary care units.