This query often evokes confusion among fellows and General physicians .
The answer is simple .Yes , you can.(With few conditions)
- Thrombolysis or PCI is done with reference to the presence or absence of ST elevation and chest pain.
- If there is ongoing chest pain and significant new onset ST elevation thrombolysis or PCI is indicated whether there is associated q waves or not.
Clinical situations
Ischemic q waves: Q wave can occur with transmural ischemia which result in electrical stunning and loss of R waves . (Many of them regenerate this R within few days after STEMI , indicating the q waves can be ischemic in origin)
Reinfarction : Patients with old MI can develop fresh ST elevation in q leads due to tachycardia and dyskinetic infarct segment .This group of patients should be carefully evaluated before labeling them as re-infarction
* q RBBB in early hours of anterior STEMI is fairly common which may revert later. qRBBB is not a contraindication for re-perfusion .
Final message
Presence of q waves does not imply one should not entertain thrombolysis or PCI .The decision to reperfuse , rather goes with presence of chest pain , ST elevation and of course within the acceptable time window!
Dr.S.Venkatesan MD 