tag:blogger.com,1999:blog-549949223388475481.post1740222211817428867..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Subtle Anterior Transient Injury Pattern, Not Appreciated, LAD occlusion spontaneously reperfusedUnknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-82756418481925861912013-10-06T08:20:03.155-05:002013-10-06T08:20:03.155-05:00See above!See above!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40580045673903977392013-10-06T08:11:47.869-05:002013-10-06T08:11:47.869-05:00I don't see ST depression in V4, but I do see ...I don't see ST depression in V4, but I do see it in V5 and I would agree wiith your astute observation that this is a de Winter's T-wave.<br /><br />Thanks,<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64672487138239889652013-09-26T16:58:20.778-05:002013-09-26T16:58:20.778-05:00hi doctor
i noticed STD in V5 immediately followe...hi doctor<br /><br />i noticed STD in V5 immediately followed by a tall large T wave wich is originating directly from the depressed ST segment, is that a De Winter's sign ?<br /><br />thank you very much<br /><br />Dr Bensekrane Lotfi Djilali.bornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39918542254875363002013-09-25T18:32:05.824-05:002013-09-25T18:32:05.824-05:00hi doctor.
i can see in V4 an STD followed by a t...hi doctor.<br /><br />i can see in V4 an STD followed by a tall hyperacute-looking T wave wich is taking origine in the STD, is this a De winter's T wave indicating an abtuse phenomenon is going on in the LAD ?<br /><br />thank you very much<br /><br />Dr Bensekrane Lotfi Djilali.bornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-42430208121080036662012-01-31T19:17:30.005-06:002012-01-31T19:17:30.005-06:00Duke, thanks for the interesting info and feedback...Duke, thanks for the interesting info and feedback!<br /><br />Great work on your part. If he hadn't gone to the stab room, they probably would not have shown me the ECG.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64512705033667284282012-01-31T16:53:55.444-06:002012-01-31T16:53:55.444-06:00I'm one of the medics you noted as being "...I'm one of the medics you noted as being "worried" about this patient's condition. Your post is the first feedback I've received on this guy's outcome.<br /><br />Yeah, we were worried. The patient was worried and his panicked wife called several times in the few minutes we were on scene.<br /><br />We had an obviously sick patient on our stretcher and didn't quite know why - other than the facts of his presentation and an abnormal ECG that we couldn't decipher.<br /><br />So we did what any experienced set of medics would have done.... We hustled him to Stabilization Room.<br /><br />All kidding aside; This patient did as well as he did only because of you, Dr Smith. Good work. <br /><br />This patient and his family will probably never know just how fortunate he was to have you stroll by his cubicle.Dukehttps://www.blogger.com/profile/12212648800638886823noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85637884027500070952012-01-20T10:54:18.293-06:002012-01-20T10:54:18.293-06:00There are many studies on 12 lead or 3 lead monito...There are many studies on 12 lead or 3 lead monitoring. One in the ED by Fesmire showed impressive improvement in senstivity and specificity for STEMI: <br /><br />Fesmire FM. Ann Emerg Med 1998;31(1):3-11.<br /><br />STUDY OBJECTIVE: To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain. METHODS: A prospective observational study was performed in 1,000 patients with chest pain who were admitted to a university teaching hospital and who underwent continuous ST-segment monitoring with SECG during the initial ED evaluation. The initial ECG was obtained on presentation, and SECG readings were obtained at least every 20 minutes during the ED evaluation. Diagnostic abnormalities on the initial ECG were defined as injury or ischemia. Diagnostic changes on SECG were defined as evolving injury, evolving ischemia, new injury, or new ischemia. ACS was defined as acute myocardial infarction (AMI), recent myocardial infarction or unstable angina. RESULTS: A diagnostic SECG was more sensitive than a diagnostic initial ECG for detection of AMI (68.1% versus 55.4%; P < .0001) and ACS (34.2% versus 27.5%; P < .0001). A diagnostic SECG was more specific than a diagnostic initial ECG for detection of ACS (99.4% versus 97.1%; P < .01). SECG detected injury in an additional 16.2% of AMI patients compared with the initial ECG (61.8% versus 45.6%; P < .0001; 95% confidence interval for difference of proportions, 10.9% to 21.4%). CONCLUSION: SECG during the initial ED evaluation is more sensitive and more specific than the initial ECG in the identification of ACS. Patients with a diagnostic SECG need intensive antiischemic therapy, evaluation for reperfusion therapy, and admission to an ICU.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37542902526488802862012-01-20T10:43:26.427-06:002012-01-20T10:43:26.427-06:00Very enlightening case sir. It goes to show that A...Very enlightening case sir. It goes to show that ACS is a dynamic event. We are reminded that the 12L is just a 10 second window of a dynamic event. Out of "free imagination", a lot could be seen in telemetry if there is a way to monitor representative leads of the anterior wall. I noticed that a telemetry system now can monitor 2 V leads aside from the regular limb leads. I do not know how cost effective could this be (anterior wall monitoring) if we run a cost-efficiency analysis vs. the usual care of such a case. It would be nice to know. We might even see that a NSTEMI is really an STEMI in real time monitoring.Anonymousnoreply@blogger.com