Looks very much a infarct of infero posterior territory is it not ?
Have a look at her 2D echo still picture . . .
Are you convinced ?
This women had normal LV systolic and diastolic function with no evidence of constriction.
The explanation for the asymptomatic pericardial thickening is due to a healed chronic pericarditis .This sort of localised thickening in the posterior aspect is all the more likely following a loculated pericardial effusion.Tuberculosis is a very likely etiology.But this women do not have any markers for tuberculosis.Since she is symptomatic no treatment was offered.She is being followed up.
Discussion .
Q waves are not ” sacred waves” to diagnose myocardial infarction.It simply indicates the direction of current flow is away from the recording lead of the ECG .Any thing electrically inert , that come in the interface between the heart and the recording electrode can record a q waveWhat are the pathological entities that can produce q waves other than infarct ?
- Fibrotic myocardium(DCM-Cardiomyopathy)
- Myocardial Scars
- Myocyte dis array(LVH, HCM)
- Air,fluid in pericardium /pleural space
- Pericardial thickening (As in this patient)
- Electrical shortcircuits (WPW syndrome)
- Rarely pure ischemia without necrosis can produce q waves (Electrically stuned myocardium)
Final message
Localised pericardial thickening is a rare (?unrecognised) cause for pathological q waves , that may mimic a MI.
Dr.S.Venkatesan MD 