Three cases illustrating the importance of the endocardial extent of infarction and its location for the QRS score. A. A small transmural, non–Q wave myocardial.

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Three cases illustrating the importance of the endocardial extent of infarction and its location for the QRS score. A. A small transmural, non–Q wave myocardial infarction in the inferior left ventricular (LV) wall with a QRS score of 0 and myocardial infarction size of 2% of the LV by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR). B. A nontransmural, Q wave myocardial infarction in the inferior LV wall with a QRS score of 8 with the following criteria met: Q duration >30 ms in lead II; Q duration >40 ms and R/Q ratio <1 in lead aVF; R duration >40 ms in lead V1; R duration >50 ms in lead V2; and Q duration >30 ms in lead V6. Infarct size by LGE CMR was only 7% of the LV. The endocardial extent, however, measured 24% of the LV endocardial extent, closely resembling the QRS score of 8 (24% of the LV). C. A transmural, non–Q wave myocardial infarction in the posterolateral LV wall. This patient had prominent R waves and small S waves in V1 and V2 suggestive of posterolateral myocardial infarction. Arrows indicate either myocardial infarction by LGE CMR or QRS changes generating QRS points. 2ch, two-chamber long axis view. Reproduced with permission from Engblom et al.127 Source: Chapter 7. Electrocardiography of Ischemic Heart Disease, Multimodal Cardiovascular Imaging: Principles and Clinical Applications Citation: Pahlm O, Wagner GS. Multimodal Cardiovascular Imaging: Principles and Clinical Applications; 2011 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/wagn/wagn_c007f010.jpg&sec=40664760&BookID=382&ChapterSecID=40663658&imagename= Accessed: October 26, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved