tag:blogger.com,1999:blog-549949223388475481.post1360858099807688503..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Is the LAD really completely occluded when there are de Winter's waves?Unknownnoreply@blogger.comBlogger15125tag:blogger.com,1999:blog-549949223388475481.post-44335914995147232992019-04-18T10:21:03.876-05:002019-04-18T10:21:03.876-05:001) most ischemia is gone from the lateral leads, a...1) most ischemia is gone from the lateral leads, as also seen in V5, V6.<br />2) Waiting for cath team to arriveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41018734724511713822019-04-18T05:03:56.049-05:002019-04-18T05:03:56.049-05:00Hi Smith, why the second ECG just before cath is s...Hi Smith, why the second ECG just before cath is showing changes only in anterior leads while no upslopping st depression is noted in high lateral leads, another question what is reason behind doing ECG just before Cath, i mean they have the confirmed diagnosis and cath lab is already activated?<br /><br />thanksAnonymoushttps://www.blogger.com/profile/13695727937223801706noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54428368821348761202017-07-01T11:48:14.109-05:002017-07-01T11:48:14.109-05:00This is what I believe, and have evidence for, but...This is what I believe, and have evidence for, but it is hard to proveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60595477326828225932017-06-22T21:39:53.993-05:002017-06-22T21:39:53.993-05:00So the wellens waves indicate complete reperfusion...So the wellens waves indicate complete reperfusion while de winters indicate only small reperfusion ??<br />Iam right or not?Anonymoushttps://www.blogger.com/profile/09140689026107196843noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76580825158360416112015-06-17T06:53:34.134-05:002015-06-17T06:53:34.134-05:00Jerry,
Thanks for the feedback. Great comments.
S...Jerry,<br />Thanks for the feedback. Great comments.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85327363724653055362015-06-16T22:31:23.789-05:002015-06-16T22:31:23.789-05:00Steve...
I just encountered your post here a year...Steve...<br /><br />I just encountered your post here a year later (June 2015). I think you really hit the nail on the head when you relate the De Winter T waves to subendocardial ischemia. They certainly fit the morphology of regional subendocardial ischemia. Regional subendocardial ischemia is characterized by ST depression with upright T waves. It is not so generalized as circumferential subendocardial ischemia and is typically due to a partial occlusion of a major vessel or complete occlusion of a less extensive branch. The first stage of ischemia - even for subendocardial ischemia - is the appearance of hyperacute T waves. However, the ST depression of subendocardial ischemia is certainly not limited to an upward sloping ST segment.<br /><br />Thanks for the great posts!<br /><br />Jerry W. Jones, MD FACEP FAAEMJerry W. Jones, MD FACEPhttp://www.advancedecgcourse.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-56602274704375016732014-07-11T17:22:57.085-05:002014-07-11T17:22:57.085-05:00Joseph,
I would definitely thrombolyse a patient ...Joseph,<br /><br />I would definitely thrombolyse a patient with de Winter's T-waves. Believe it or not, the data against thrombolysing ST depression is nowhere near convincing. It was done in 4 studies: ISIS-2, GISSI-1, LATE, and TIMI IIIB. Numbers were small, time to thrombolysis was long (in TIMI IIIB, the most imporant study against ST depression, mean time to tPA was 9 hours. In GISSI, only 2 leads with ST depression of 1 mm were required. So the data on thrombolysis of severely stenotic but open thrombotic lesions, manifesting as ST depression, does not exist. <br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79872690257219234782014-07-11T11:01:37.981-05:002014-07-11T11:01:37.981-05:00would you thrombolyse someone with DeWinter T-wave...would you thrombolyse someone with DeWinter T-waves? Will it provide benefit like PCI will?Joseph Madisonnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73251088950117478322014-07-10T21:52:23.486-05:002014-07-10T21:52:23.486-05:00NICE post Steve! Interesting how over the past sev...NICE post Steve! Interesting how over the past several years since I've been looking for DeWinter T waves - I've seen this phenomenon more and more in a variety of "partial forms" - each of which I imagine shows some state of high-grade narrowing but incomplete occlusion. I like your theory on the operative physiology! THANKS for posting - :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61377545710442762272014-07-08T15:32:44.697-05:002014-07-08T15:32:44.697-05:00Thank you for clarifying this for me!Thank you for clarifying this for me!Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23125407952936553722014-07-08T15:24:46.336-05:002014-07-08T15:24:46.336-05:00The T-waves are rarely deeply inverted in aneurysm...The T-waves are rarely deeply inverted in aneurysm. There are exceptions, I am sure. But I haven't seen any. Usually well developed Q-waves with shallow T-wave inversion. On the other hand, well developed STEMI that reperfuses before complete transmural infarction still has a significatn amount of viable myocardium and can have very deeply inverted T-waves.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-11100300968211252332014-07-08T14:33:06.854-05:002014-07-08T14:33:06.854-05:00So is the depth of the T-wave directly proportiona...So is the depth of the T-wave directly proportional to the viable myocardium remaining? I'm just thinking that there are deep T-waves in aneurysms, where there is no viability anymore. Or do they get deeper in a late stage?Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-52538822042443319332014-07-08T08:15:35.921-05:002014-07-08T08:15:35.921-05:00Ana,
2 ways:
1) when a transmural MI is completed...Ana,<br /><br />2 ways:<br />1) when a transmural MI is completed, there is indeed T-wave inversion but it is shallow. The depth correlates with the amount of viable myocardium remaining<br />2) when complete transmural MI, expect Q-waves, especially QS-waves<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59920855239240366832014-07-05T10:23:04.081-05:002014-07-05T10:23:04.081-05:00DeWinter's wave- explanation is very good.Than...DeWinter's wave- explanation is very good.Thanks.<br />Dr.ChidAnonymoushttps://www.blogger.com/profile/04830759426997933675noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65230181900991182432014-07-05T00:45:12.585-05:002014-07-05T00:45:12.585-05:00There's one question I've been meaning to ...There's one question I've been meaning to ask for a while. In the classic ECG in STEMI there is the stage with negative T-waves, even in the untreated MI (closed artery that stays closed, right?). So how do you differentiate that from reperfusion T-waves?Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.com