Which one of the following findings is the most specific for the diagnosis of Myocardial Infarction?
- An akinetic area of Left Ventricle
- Elevated cardiac enzymes
- ST Segment elevation on ECG
- Positive history of severe chest pain
- Evolution of Q waves on the ECG
ANSWER (5) Evolution Q Waves on the ECG
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GREAT question above - though I would think the answer would depend on HOW one defines "myocardial infarction". I'd be curious as to the documentation for the correctness of Choice 5 (and would hope that the documentation didn't use ECG development of Q waves as it's "gold standard" .... ). Depending on the time course used to define Choice 5 - there are other reasons why patients may develop Q waves over time ...
ReplyDeleteI agree with ECG Interpretation - but given the right history most specific feature of a completed MI would be dyskinetic or hypokinetic or akinetic area on the echocardiogram.
ReplyDeleteQ waves can be present due to multiple reasons.
I actually agree with Anonymous. Q waves was NOT my choice for the answer (I also chose an akinetic area). The point I was trying to make is that sometimes studies are done to assess accuracy of a diagnostic test using "itself" as the gold standard to compare with other tests - and that methodology is flawed. My suspicion is that if "Q waves" are written up somewhere as the most specific feature of a "completed MI" - that the study that showed this may have suffered from that flaw ... but I am not familiar with whatever study looked at this so I couldn't say. Then again IF by "evolution" what one meant was on Day 1 NO chest pain; No Q wave - then Day 2 there is chest pain and positive troponins and cath proof of an acute infarct and shortly thereafter evolves a Q wave - then that Q wave was specific ... but then again, there were also positive troponins and cath proof ... ergo my question as to how "the Answer" to this question was derived ...
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