Abnormal Q Waves on the EKG While the vast majority of abnormal Q waves are due to myocardial infarction (MI), others can be caused by other cardiac illnesses such as hypertrophic cardiomyopathy (the result of long-standing high blood pressure) and may simulate anterior or inferior myocardial infarction. An unexpected change such as this on a routine EKG should be evaluauted with a cardiology consultation, a stress ECHO, and probably a CTCA Scan.