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  • Title: [Transmural myocardial infarction. An impossible electrocardiographic diagnosis].
    Author: Hallali P, Haiat R.
    Journal: Ann Cardiol Angeiol (Paris); 1985 Jun; 34(6):401-4. PubMed ID: 4026167.
    Abstract:
    The anatomical and experimental data clearly show that transmural myocardial infarction does not always produce a pathological Q wave on the ECG, but may sometimes only cause abnormalities of the ST segment and the T wave. Conversely, a sub-endocardial myocardial infarction may present with pathological Q waves. Schematically, the histology of transmural myocardial infarction usually reveals so-called coagulation necrosis, while sub-endocardial myocardial infarction generally corresponds to myofibrillary degeneration (contraction band necrosis), which promotes a reperfusion process. Very often, however, the histological appearance is not so clear-cut and the features tend to overlap. Consequently, in practice, it does not seem justified to use the electrocardiogram as a basis to distinguish between transmural and sub-endocardial infarctions, in terms of prognosis, or to select possible candidates for coronary angiography following a first myocardial infarction.
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