Inferior lead pseudo-infarct Q waves are a common finding in the Wolff-Parkinson-White (WPW) syndrome.The characteristic Q wave-T wave vector discordance results from secondary repolarization changes due to altered ventricular activation. As a corollary, the presence of T wave inversion with inferior lead Q waves and a short PR interval is strongly suggestive, but not pathognomonic of inferior ischemia.

1. PSEUDO MYOCARDIAL
INFARCTION
AIIMS BHUBANESWAR

2. ECG CONDITIONS THAT MIMIC MYOCARDIAL INFARCTION EITHER BY SIMULATING
PATHOLOGIC Q OR QS WAVES OR MIMICKING THE TYPICAL ST-T CHANGES OF ACUTE MI
• WPW preexcitation (negative delta wave may mimic pathologic Q waves)
• IHSS (septal hypertrophy may make normal septal Q waves "fatter" thereby mimicking pathologic Q waves)
• LVH (may have QS pattern or poor R wave progression in leads V1-3)
• RVH (tall R waves in V1 or V2 may mimic true posterior MI)
• Complete or incomplete LBBB (QS waves or poor R wave progression in leads V1-3)
• Pneumothorax (loss of right precordial R waves)
• Pulmonary emphysema and cor pulmonale (loss of R waves V1-3 and/or inferior Q waves with right axis deviation)
• Left anterior fascicular block (may see small q-waves in anterior chest leads)
• Acute pericarditis (the ST segment elevation may mimic acute transmural injury)
• Central nervous system disease (may mimic non-Q wave MI by causing diffuse ST-T wave changes)

3. CASE VIGNETTE
• A 62yrs woman presented with frequent episodes
of palpitation for last 7-10yrs
• Palpitation was more marked during bathing
• No other comorbidities
• ECG :RIGHT FREE WALL PATHWAY
• ECHO study was normal

4. LOCALISATION KENT BUNDLE

5. RIGHT LATERAL PATHWAY:THE WOLFF-
PARKINSON-WHITE SYNDROME
• Negative delta and negative QRS in
V1
• QS in inferior leads
• Discordant T in the inferior leads: T is
upright when there is QS in these
leads
• Left axis deviation

6. IT IS NOT TOO LATE TO LEARN AT ANY AGE