Dr. Smith's ECG Blog

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.

Monday, November 10, 2008

t wave inversion

t wave inversion from hqmeded.com on Vimeo.

Posted by Scott Joing at 9:02 PM

Email This BlogThis!Share to Twitter Share to Facebook

Labels: early repolarization, T-Wave inversion

Reactions:

No comments:

Disclaimer

Disclaimer: I never state from where I get a case. They come from all over the world. Any case may or may not be from my own institution. Do not make any assumptions. Patient identifiers have been redacted or patient consent has been obtained. The contents of this site have not been reviewed nor approved by Hennepin County Medical Center and any views or opinions expressed herein do not necessarily reflect the views or opinions of Hennepin County Medical Center

about Dr. Smith

Dr. Stephen W. Smith is a faculty physician in the

Emergency Medicine Residency at
Hennepin County Medical Center (HCMC)
in Minneapolis, MN, and
Associate Professor of Emergency Medicine at the
University of Minnesota.

Smith-Modified Sgarbossa Rule for Diagnosis of STEMI in the Presence of Left Bundle Branch Block

Here is a link to the pdf of the article

The equation for differentiating the ST elevation (STE) of subtle LAD occlusion from early repol

Here is a link to the full text of the article in Annals of EM

It is critical to use it only when the differential is subtle LAD occlusion vs. early repol. If there is LVH, it may not apply. If there are features that make LAD occlusion obvious (inferior or anterior ST depression, convexity, terminal QRS distortion, Q-waves), then the equation MAY NOT apply. These kinds of cases were excluded from the study as obvious anterior STEMI. ST elevation (STE) is measured at 60 milliseconds after the J-point, relative to the PR segment, in millimeters.

(1.196 x STE at 60 ms after the J-point in V3 in mm) + (0.059 x computerized QTc) - (0.326 x R-wave Amplitude in V4 in mm).

Use the calculator below. A value greater than 23.4 is quite sensitive and specific for LAD occlusion.

Total Pageviews

Comments not appropriate for general posting, or interesting ECGs, may be sent here (do this judiciously!): dr.smiths.ecg.blog@gmail.com.

I highly recommend using this blog as an atlas or textbook. Use the "label" below the archive (below) to search for all kinds of ECG cases, with discussion.

Follow on Twitter @smithECGBlog

Follow @smithECGBlog

Tweet this

Subscribe To

Posts

Atom

Posts

Comments

Atom

Comments

Search This Blog

Loading...

Video Lectures of Dr. Smith

The Best of Smith (2 hours on subtle occlusion from Best of Hennepin conference)

Here is a lecture on the diagnosis of Acute MI in the presence of left bundle branch block

Here is a lecture on Acid-Base Disorders (55 minutes)

Here are 2 lectures on Acute Coronary Syndromes on hqmeded.com. ACS 1 is on Unstable Angina and NSTEMI. ACS 2 is on STEMI. Each is one hour.

Here are 2 lectures: narrow complex tachycardia and wide complex tachycardia.

The blog is featured on Podcast 42 of EMCrit, with an interview on various aspects of the ECG in MI, and another EMCrit feature on left bundle branch block, with an interview.

Links

ECG Teacher -- outstanding site, especially for novices
Critical Decisions in Acute Care electrocardiography -- ACS section by Dr. Smith
EMS 12-Lead
Ken Grauer's excellent EKG site
Dr. Smith's book (Amazon) (now out of print and out of stock; some used copies available, hoping to publish it electronically)
EM Crit
hqmeded.com

Followers

Blog Archive

2013 (103)
- December (4)
- November (8)
- October (9)
- September (8)
- August (12)
- July (8)
- June (15)
- May (10)
- April (8)
- March (10)
- February (4)
- January (7)

2012 (79)
- December (5)
- November (6)
- October (7)
- September (5)
- August (8)
- July (5)
- June (6)
- May (8)
- April (9)
- March (8)
- February (5)
- January (7)

2011 (97)
- December (6)
- November (7)
- October (8)
- September (9)
- August (8)
- July (4)
- June (11)
- May (9)
- April (14)
- March (6)
- February (9)
- January (6)

2010 (48)
- December (10)
- November (6)
- October (5)
- September (1)
- August (4)
- July (4)
- June (2)
- May (2)
- April (2)
- March (3)
- February (1)
- January (8)

2009 (22)
- December (2)
- November (2)
- October (4)
- August (3)
- June (3)
- April (2)
- March (1)
- February (3)
- January (2)

2008 (8)
- December (1)
- November (7)

hqmeded on YouTube

Loading...

Labels (Index)

Aberrant conduction (2)
accelerated idioventricular rhythm (1)
accelerated junctional rhythm (1)
Acidosis (1)
aconite (1)
acute right heart strain (1)
acuteness (1)
algorithm (5)
alkalosis (1)
alternating BBB (1)
anterior STEMI equation (7)
Anterior STEMI with minimal ST elevation less than 1 mm (7)
anterior T wave inversion (6)
Arrhythmogenic Right ventricular dysplasia (1)
asthma (1)
Atrial enlargement and hypertrophy (1)
atrial flutter (7)
atrial repolarization wave (2)
atrial_fibrillation (4)
atrial_fibrillation with RVR (2)
Atypical Symptoms (1)
AV block (6)
AV dissociation (6)
aVL (10)
aVR (8)
Benign T-wave Inversion (3)
bidirectional tachycardia (1)
bradycardia (3)
brugada (3)
Cabrera's sign (2)
carbon monoxide poisoning (1)
cardiac arrest (11)
cardiac memory (1)
cardiogenic shock (1)
cardioversion (1)
Chapman's sign (1)
circumflex occlusion (6)
Co-culprit lesions (1)
collateral circulation (1)
computer (7)
concordance (2)
coronary embolism (1)
de Winter's T-waves (2)
demand ischemia (1)
Diagonal branch (D1 or D2) (2)
diffuse ST Elevation (1)
digitalis (4)
digoxin (3)
discordant (2)
Dr. K. Wang (14)
droperidol (1)
Drug Effect (1)
Dynamic T-waves (4)
early repolarization (11)
Early Repolarization with Dynamic T-waves (1)
echocardiogram (7)
electrical alternans (1)
electrocardiographically silent (1)
Enhanced atrioventricular nodal conduction (EAVNC) (1)
Equation for Early Repol vs. Anterior STEMI (3)
evolving STEMI (5)
exaggerated STE (1)
excessively discordant ST depression (1)
false negative cath lab activation (1)
false positive cath lab activation (10)
fascicular VT (2)
Formula for Early Repol vs. Anterior STEMI (3)
fractional flow reserve (1)
fragmented QRS (3)
fusion beat (1)
high lateral MI (4)
high lateral STEMI (2)
hyperacute T-waves (16)
hypercalcemia (1)
hyperkalemia (15)
hypertension (1)
Hypertrophic Cardiomyopathy (2)
hypocalcemia (1)
hypokalemia (9)
hypothermia (1)
idiopathic ventricular tachycardia (1)
Inferior Aneurysm Morphology (1)
inferior early repolarization (2)
inferior hyperacute T-waves (5)
inferior ST depression (10)
inferior STEMI (6)
inferoposterior STEMI (4)
intracranial hemorrhage (1)
intravascular ultrasound (1)
Intraventricular conduction delay (1)
J-waves (1)
junctional escape (1)
LAD occlusion (9)
LAD occlusion vs. benign early repolarization (17)
Ladder Diagram (3)
lateral STEMI (1)
LBBB (23)
left bundle branch block (11)
left main (5)
Lewis Lead (1)
long QT (4)
Lown-Ganong-Levine (1)
LV aneurysm (15)
LVH (14)
Mid anterolateral MI (1)
mirror image (1)
missed STEMI (12)
mural thrombus (1)
myocardial contusion (3)
myocardial rupture (4)
Myocarditis (1)
New LBBB (9)
New sign of LAD occlusion (1)
nitroglycerin (1)
nondiagnostic ECG (1)
NonSTEMI (2)
normal angiogram in ACS (1)
normal ECG (1)
NOT-pseudonormalization (2)
NSTEMI (2)
obtuse marginal (2)
Occlusion with less than 1mm ST Elevation (7)
osborn waves (1)
paced rhythm (3)
pacing (4)
Peaked T waves (1)
Pediatric (4)
pericarditis (10)
persistent STE (4)
poisoning (1)
posterior fascicular idiopathic VT (1)
posterior leads (4)
posterior reperfusion T-waves (7)
posterior STEMI (9)
postinfarction regional pericarditis (2)
prehospital ECG (8)
Previous ECG (3)
progression of STEMI (2)
proportion (1)
pseudo RVMI (1)
pseudoinfarction (16)
pseudonormalization (5)
pulmonary edema (3)
pulmonary embolism (6)
PVC (6)
q-waves (3)
QRS prolongation (1)
QS-waves (3)
QTc (1)
RBBB (22)
RBBB with LAFB (Left Anterior Fascicular Block) (1)
re-occlusion (3)
reciprocal ST depression (8)
reciprocal T-wave inversion (1)
reocclusion (4)
reversible T-wave inversion (1)
right bundle (5)
right sided leads (2)
Right Ventricular Hypertrophy (4)
Risks and risk factors for lytics/PCI (1)
RV dysplasia (1)
RV MI (3)
RVH (4)
RVMI in lead V1 (5)
RVOT (right ventricular outflow tract ventricular tachycardia) (1)
saddleback STE (3)
Sasaki rule (1)
scooped ST depression (1)
Septal STEMI (2)
serial ECG (19)
serial EKG (8)
short QT (3)
sick sinus (2)
signs of reperfusion (4)
sino-atrial exit block (2)
Sinus Pause/Sinus Arrest (1)
Sinus Tachycardia Extreme (1)
Sodium Channel Blockade (1)
Spasm (2)
spontaneous reperfusion (8)
ST depression (20)
ST elevation (4)
ST resolution (1)
ST Segment Monitoring (2)
STEMI (3)
STEMI vs. NonSTEMI (2)
STEMI with less than 1 mm ST elevation (8)
STEMI-equivalent (1)
stokes-adams (1)
straight ST segments (1)
stress cardiomyopathy (3)
subacute MI (4)
subarachnoid hemorrhage (2)
subendocardial ischemia (2)
subtle (16)
SVT with aberrancy (4)
Syncope (4)
T-Wave inversion (13)
tachycardia (1)
takotsubo (2)
terminal QRS distortion (2)
Third (3rd) degree AV block (1)
TIMI myocardial perfusion grading (1)
torsade (2)
Toxicology (1)
transient ST elevation (4)
transient T-wave inversion (1)
Tricyclic antidepressant (1)
troponin (2)
type II MI (2)
type III LAD (2)
Type_III_wraparound_LAD (1)
U-waves (8)
ultrasound (2)
unstable angina (5)
upside down (1)
Valvular disorder (1)
ventricular fibrillation on a 12 lead (1)
ventricular tachycardia (8)
Ventricular Tachycardia without structural cardiac abnormality (2)
Wellens' in inferior or lateral leads ("reperfusion T-waves") (2)
Wellens' syndrome (14)
Wellens' Syndrome - NOT!! (1)
wenckebach (2)
wide complex (8)
wide QRS (3)
wide_complex_tachycardia (13)
Widespread ST Elevation (1)
wolff parkinson white WPW (6)
wraparound LAD (6)
Young Women (2)

Awesome Inc. template. Powered by Blogger.

Monday, November 10, 2008

t wave inversion

No comments:

Post a Comment