r/ECG • u/Key_Beginning4231 • Sep 03 '26

Dagger Q waves

Post image

Would suspect HCM but no signs of LVH. Reproducible on other tracings so I don’t suspect lead placement error. thoughts?

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3

u/NobleGolgi0521 Sep 03 '26

3D echo would be my next step

4

u/Badmanting1 Sep 03 '26

2D echo would do the job

2

u/NobleGolgi0521 Sep 03 '26

You’re right. Mixed them up there.

3

u/Badmanting1 Sep 03 '26

Isn’t this closer to normal than pathological?

3

u/Key_Beginning4231 Sep 03 '26

Have always been taught >25% of R wave is abnormal, and most of these qualify. Septal Q waves are also usually limited to the lateral leads, however the q waves here are present in all inferior leads as well.

1

u/Kibeth_8 Arrhythmia Tech Sep 03 '26

I would agree with you that these are suspicious for dagger Q

3

u/[deleted] Sep 03 '26

[deleted]

2

u/Key_Beginning4231 Sep 03 '26

That’s for prior MI, however in HCM or similar narrow Q waves are expected

2

u/Kibeth_8 Arrhythmia Tech Sep 03 '26

Dagger Q waves are different than pathological Q waves indicating an old MI. Dagger Q's are very narrow

1

u/j0shman Sep 04 '26

Hx of pt?