The challenge of inferior Q waves

The presence of unexpected Q waves in an applicant's electrocardiogram poses a diagnostic dilemma for the medical director. On the one hand, the Q waves may be the remnants of a previously unsuspected "silent" myocardial infarction. Conversely, unexpected Q waves may represent a normal or positional variant, or an important noncoronary type of heart disease. This case study illustrates some of the pitfalls in interpreting applicants' electrocardiograms containing Q waves in the inferior leads.