tag:blogger.com,1999:blog-549949223388475481.post1291558042158652161..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Anterior STEMI? Or Benign Early Repolarization?Unknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-10128553659091086542016-07-13T05:02:36.724-05:002016-07-13T05:02:36.724-05:00I don't think this looks much like hypokalemia...I don't think this looks much like hypokalemia. These are typical U-waves for early repolarization, and T-waves are not flattened (some are inverted).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41708631826593424162016-07-12T18:43:05.564-05:002016-07-12T18:43:05.564-05:00The exlusion criteria is applied , and the patient...The exlusion criteria is applied , and the patient is investigated for the need for timely reperfusion. As Jerry highlights findings of prominent P wave got me thinking. With the prodrome days of diarrhoea it had me looking for the potential for hypokaleamia on the ECG. When ischaemia is excluded could the P waves , T wave flattening and inversion , ST depression and U waves indicate this as a co differential ?Anonymoushttps://www.blogger.com/profile/09735247860751556681noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54513119032668658332016-06-20T09:18:36.646-05:002016-06-20T09:18:36.646-05:00Great comments as usual, Jerry.
Thanks,
SteveGreat comments as usual, Jerry.<br />Thanks,<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22039569059746709642016-06-18T16:36:52.394-05:002016-06-18T16:36:52.394-05:00Paul,
Indeed they are. I forgot to point that out ...Paul,<br />Indeed they are. I forgot to point that out and am glad to get comments on that.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80241246326829128902016-06-18T16:06:01.758-05:002016-06-18T16:06:01.758-05:00Thanks Steve — I feel MUCH better hearing your ans...Thanks Steve — I feel MUCH better hearing your answer — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87844860476351110662016-06-18T14:50:50.961-05:002016-06-18T14:50:50.961-05:00Very tough case, Steve. I noticed the P waves in t...Very tough case, Steve. I noticed the P waves in the inferior leads were rather large and gothic-appearing, though the P waves in V1 were unremarkable. It would be interesting to know if there were any history of tricuspid stenosis or anything congenital. Also, the precordial T waves are really very impressive - if not for their height then for their width. Any idea why so wide? It makes me wonder if any of his seizure meds (assuming he is taking some) might have potassium-channel blocking capability, or even if he might be taking a potassium-channel blocker (which could widen the T wave without widening the QRS). I'm not sure how many people who are post-ictal and then have a coronary occlusion or acute spasm react to the pain. If I had never seen this patient before, knew nothing of his history other than he was post-ictal and had no access to a previous ECG, I would activate the cath lab.<br /><br />Thanks for a great website!Jerry W. Jones, MD FACEP FAAEMhttps://www.blogger.com/profile/10333187745825224414noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15852692542968262502016-06-18T09:03:58.255-05:002016-06-18T09:03:58.255-05:00The inferior T-wave inversions are troubling witho...The inferior T-wave inversions are troubling without having a prior ECG for comparison.Paulnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12896710659268087052016-06-18T06:15:59.216-05:002016-06-18T06:15:59.216-05:00Ken,
I probably would have activated the cath lab....Ken,<br />I probably would have activated the cath lab.<br />Just goes to show that pretest probability is critical in making decisions based on the ECG!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51959479383298891672016-06-18T06:14:40.984-05:002016-06-18T06:14:40.984-05:00Bashar,
There is a bit of inferior ST depression i...Bashar,<br />There is a bit of inferior ST depression in aVF (in addition to inferior T-wave inversion) and, I agree, this is highly suspicious for LAD occlusion. But it goes to show that the two entities can be very difficult to differentiate.<br />Steve<br /><br />Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9609064552569080522016-06-18T06:13:36.647-05:002016-06-18T06:13:36.647-05:00All precordial leads V2-V4 do have a trace of upwa...All precordial leads V2-V4 do have a trace of upward concavity, to my eye. There is a bit of inferior ST depression in aVF and, I agree, this is highly suspicious for LAD occlusion. But it goes to show that the two entities can be very difficult to differentiate.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51527193307600010192016-06-17T21:46:10.651-05:002016-06-17T21:46:10.651-05:00Insightful case! I am curious Steve — How would yo...Insightful case! I am curious Steve — How would you have interpreted this tracing if the patient was new to the Emergency Department and presented with new-onset chest pain but no prior tracing was available? This is admittedly a rhetorical question, which I suspect the 3 last lines under your “Learning Point” answers. THANK YOU for presenting this case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49807254115823939782016-06-17T19:52:39.447-05:002016-06-17T19:52:39.447-05:00Difficult one
V3 is especially indicating STEMI
...Difficult one <br /><br />V3 is especially indicating STEMI<br /><br />What about the ST depression and TWI on inferior leads<br /><br />Thanks for the case ..<br />Anonymoushttps://www.blogger.com/profile/08488975105375814621noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81022931864553863042016-06-17T14:41:39.928-05:002016-06-17T14:41:39.928-05:00Concave vs Convex, this case is Convex, not concav...Concave vs Convex, this case is Convex, not concaved i.e., Notch, J hook, Smiley face, etc..Anonymoushttps://www.blogger.com/profile/07065498167426672315noreply@blogger.com