There are some electrocardiographic "normal variant" abnormalities which are not suggestive of any underlying heart disease. But if those abnormalities are more pronounced, or occur in a certain context, then they may be interpreted differently. For instance the presence of the Q wave in the absence of ST and T wave abnormality generally indicates prior or healed heart attack. Although the presence of a Q wave with a 40 msec duration is sufficient for diagnosis. The condition of an old MI has been ruled out.
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