Traditional Teaching Holds That

Abnormal Q waves reflect Necrosis, ST-segment Changes reflect injury and T waves Changes reflect ischemia. This is overly simplistic. The Q waves may reflect temporary electrical silence and not necessary Necrosis. Both ST-segment and T wave changes may be due to ischemia, injury or Necrosis.

Complete normalization of the ECG following Q wave infarction is uncommon but can occur particularly with smaller infarcts and when the LV ejection fraction and regional wall motion improve. This is usually associated with spontaneous recanalization or good collateral circulation and is a good prognostic sign.

De Winter complex is characterized by an upright T wave similar to hyper acute T waves. However the condition doesn’t progress to ST-segment elevation and remain static. It is associated with acute left anterior descending artery occlusion.