tag:blogger.com,1999:blog-549949223388475481.post1418036542102915790..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Rupture of Aneurysm of the Sinus of Valsalva Presenting as Cardiogenic Shock and Severe IschemiaUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-91254225155168255032016-01-14T04:06:30.674-06:002016-01-14T04:06:30.674-06:00GREAT case. Thanks for presenting!GREAT case. Thanks for presenting!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63424744402272511242016-01-13T13:40:42.414-06:002016-01-13T13:40:42.414-06:00Aigars,
I agree Nitro not indicated. But morphine...Aigars,<br />I agree Nitro not indicated. But morphine is of no use. And also dangerous. <br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-5154300302110661742016-01-13T11:39:04.216-06:002016-01-13T11:39:04.216-06:00Alain,
The doc did not mention the presence or abs...Alain,<br />The doc did not mention the presence or absence of hypoxia. The best way to differentiate this pathology from PE would be oxygenation: if PE, then there would be clear lungs with hypoxia. If not PE, there would EITHER be no hypoxia, OR there would be hypoxia AND pulmonary edema. In both cases, the LV could be hyperdynamic, but in PE the RV would not be hyperdynamic. The RV should be hyperdynamic in this ruptured aneurysm case. Also, this case should have had a loud murmur.<br />So the ECG alone will not give the answer.<br />only in combination with clinical data.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82708318211912441472016-01-13T07:30:57.760-06:002016-01-13T07:30:57.760-06:00Paramedics should not give nitroglycerin if BP is ...Paramedics should not give nitroglycerin if BP is 100/70 mmhg and there is no two peripheral venous access with fluid boluss prior that. Patient became unstable. Why paramedics did not gave morphine and heparin to the patient...Anonymoushttps://www.blogger.com/profile/07719421023467955929noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29930632084427332432016-01-12T20:06:26.574-06:002016-01-12T20:06:26.574-06:00Interesting case. Would you comment on V1 mild ST ...Interesting case. Would you comment on V1 mild ST elevation, compared to low ST in V2, plus RBB appearance, plus unspecific tachy, related to a RV strain from left to right shunting, and about a possible Ddx of PE (I guess unstable RV isolated infarct won’t produce all this). I guess massive low ST + AVR elevation would probably not be explained just by PE. Many thanks!Alain Vadeboncoeurhttps://www.blogger.com/profile/06938164177722777952noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14537149905208780212016-01-12T07:07:30.476-06:002016-01-12T07:07:30.476-06:00Not sure, but balloon pumps only support diastolic...Not sure, but balloon pumps only support diastolic pressure, and this is critical for coronary perfusion. The coronary perfusion here is not good. Seems to me that the biggest problem is diastolic hypotension, NOT left to right shunt with hypoxia.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47351443254300209512016-01-11T18:27:26.578-06:002016-01-11T18:27:26.578-06:00Although off the point, I am frequently embarrasse...Although off the point, I am frequently embarrassed by how relatively little I know about reading EKGs. So .....I believe an intra-aortic balloon pump would be relatively contraindicated with a left-to-right shunt. Anonymoushttps://www.blogger.com/profile/09197943569340057398noreply@blogger.com