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Clarification of Q Waves in Lead III

David H. Spodick, MD
Arch Intern Med. 1977;137(10):1486. doi:10.1001/archinte.1977.03630220110033.
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To the Editor.—  Although their conclusions are consistent with clinical experience, the report by Bodenheimer and colleagues (Archives 137:437-439, 1977) is a curious document. In the introduction, the authors state that a Q wave in lead III becomes more prominent as the heart assumes a more horizontal position, citing Friedberg (their reference 9) and others; however, this statement contravenes both theory and common clinical experiences. Moreover, Friedberg quite clearly noted that a transverse position is associated with a Q wave in lead I and with an S wave in lead III. The authors further state "as the heart assumes a more horizontal position, the resultant vector shifts superiorly so that the Q wave becomes more prominent in this lead [III]...." This is curious, because it is the mid and terminal QRS forces that shift superiorly with a left or horizontal QRS vector. Since the Q wave represents the initial forces,


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