The presence of small q waves and decreased precordial r waves indicates a small amount of fibrosis of the anterior myocardial wall.

Biopsy specimens were obtained from the anterior wall of the left ventricle during aortocoronary bypass surgery in 79 patients with critical narrowing or occlusion of the left anterior descending artery. The percent of fibrous replacement on histological analysis was calculated using the point-count method and compared with electrocardiographic findings in the precordial leads. In specimens from 19 patients with abnormal Q waves, the percent of fibrosis ranged between 38% and 100% (mean, 61 +/- 17%). Fifteen patients had small q waves or decreased r waves, and the percent of fibrosis in these patients ranged between 20% and 45% (mean, 38 +/- 10%). Specimens from 45 patients with normal QRS complexes had between 3% and 27% (mean, 11 +/- 5%) fibrosis of the entire thickness of the anterior wall. Thus, small q waves or decreased r wave amplitude in the precordial leads indicates a lesser degree of myocardial loss than the presence of abnormal Q waves.