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June 1990

The Incidence and Prognosis of Unrecognized Myocardial Infarction

Author Affiliations

Worcester, Mass

Arch Intern Med. 1990;150(6):1350. doi:10.1001/archinte.1990.00390180148038

To the Editor.—Yano and MacLean have marred a very good article1 on unrecognized myocardial infarction with misleading terminology that has been widely rejected—equating "Q-wave" with transmural infarction.2 While most, but not all, Q-wave infarctions probably are transmural, many non—Q-wave infarctions also are transmural. At least since 1983, 2,3 most medical publications do not accept equating an electrocardiographic pattern with an anatomic pattern as in the past. Terminologic disputes are often quibbles, but not when concepts are involved. Throughout their text the authors equate "Q-wave" parenthetically as "transmural" and "non— Q-wave" as "subendocardial," which is plainly wrong. (The parentheses might sanitize this presentation if they were explained as indicating outmoded usage.)

What we actually see on electrocardiograms is abnormal Q waves or their absence and that is the appropriate mode of reporting. The knowledgeable reader will know that many Q-wave myocardial infarctions may be transmural. The less knowledgeable

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