Cagán S, Kuchárová L
Vnitr Lek. 1989 Aug;35(8):743-51.
The authors present a brief account of data reported in the recent literature on the evaluation of the Q wave in leads, II, III, aVF in clinically healthy subjects and in patients with ischaemic heart disease, in particular in conjunction with focal myocardial lesions. A marked Q wave in these leads is not necessarily a manifestation of clinical disease (it may be due to a changed position of the electric axis of the heart) and conversely the absence of the Q wave in leads II, III, aVF does not imply clinical absence of disease (most frequently a low myocardial infarction). It is not possible to differentiate Q waves in leads III and aVF into positional and abnormal ones according to their changes during deep inspiration. Q waves in the inferior leads present the picture of myocardial infarction of the lower, or frequently posterior, possibly laterally left ventricular wall. Correct evaluation of the abnormality (normality) of the genesis and development of Q waves on the electrocardiogram is possible only after integration of anamnestic data, clinical follow-up and results of auxiliary examination methods. Recording of the posterior chest leads and in particular vectorcardiographic examination and mapping of electric potentials of the heart on the body surface may prove helpful. These methods provide more detailed and spatial visualization of the electric field of the heart.
作者简要介绍了近期文献中报道的关于在临床健康受试者和缺血性心脏病患者中，对Ⅱ、Ⅲ、aVF导联Q波评估的数据，特别是与局灶性心肌病变相关的数据。这些导联中出现明显的Q波不一定是临床疾病的表现（可能是由于心脏电轴位置改变），反之，Ⅱ、Ⅲ、aVF导联中无Q波并不意味着临床上没有疾病（最常见的是低位心肌梗死）。根据深吸气时的变化，无法将Ⅲ导联和aVF导联的Q波区分为位置性和异常性Q波。下壁导联的Q波提示下壁，或常为后壁，可能还有左心室侧壁心肌梗死。只有在综合病史资料、临床随访和辅助检查方法结果后，才能正确评估心电图上Q波发生和发展的异常（正常）情况。记录后胸导联，特别是进行心电向量图检查和体表心脏电位标测可能会有所帮助。这些方法能更详细、更直观地显示心脏电场。
