Wednesday, August 11, 2010

Anterior Hyperacute T-waves diagnostic of LAD Occlusion

This series of ECGs from a patient with LAD occlusion shows hyperacute T waves in precordial leads, as well as ST elevation in V1-V3 and aVL. The second ECG was 16 minutes after the first and shows markedly increased ST elevation. The patient was taken for rapid PCI. The third ECG is post-reperfusion.






 


6 comments:

  1. Is the continued STE and TWI post-cath just indicative of the permanent myocardial infarction?

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  2. The ST elevation usually resolves eventually. However, any persistent ST elevation is consistent with more myocardial (permanent) injury, worse outcome, more CHF, etc. If it never completely resolves, 80% of these will have an LV aneurysm (especially if there is complete loss of R-wave, called a QS-wave).

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  3. Is it bad that the first ECG on its own (without a clinical picture attached to it) screams to me "Hyperkalmeia"? I'm still trying to get comfortable with differentiating hyperkalemic T-waves vs. Ischemic T-waves.

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  4. It is sometimes difficult to differentiate hyperK from hyperacute T's. In short, the T-wave in hyperK is "tented" or "pointed", and it looks this way in part because the preceding ST segment is very upwardly concave. That said, there is a lot of variation, and the best way to diffferentiat is to use the laboratory!!

    Here are some other posts that may help:
    http://hqmeded-ecg.blogspot.com/search?q=hyperkalemia

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  5. Sir, 1st ECG indicates " Proxima LAD Occlusion" - STD in Inferior leads with subtle STR in aVR. Your comment

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