tag:blogger.com,1999:blog-549949223388475481.post2782942448776889808..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: One reason we get ECGs in stroke patientsUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-86648798038819790252016-03-16T05:04:49.790-05:002016-03-16T05:04:49.790-05:00Zaid,
anterior LV aneurysm is an anterior MI, but ...Zaid,<br />anterior LV aneurysm is an anterior MI, but an old one with persistent ST elevation<br />Acute STEMI can be differentiated by the size of the T-waves relative to the QRS, specifically T/QRS ratio.<br />I have derived and validated a rule. See these posts:<br />http://hqmeded-ecg.blogspot.com/search?q=LV+aneurysm+0.36<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57872997958525969552016-03-16T05:02:01.210-05:002016-03-16T05:02:01.210-05:00Dan,
these are NOT acute findings. Stroke is the ...Dan,<br />these are NOT acute findings. Stroke is the result, not the cause of the ECG findings. ST-T changes are much less striking than QRS (Q-wave) findings. <br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2800028298572962852016-03-16T05:00:56.610-05:002016-03-16T05:00:56.610-05:00Ali,
To me, this does not look like Stress Cardiom...Ali,<br />To me, this does not look like Stress Cardiomyopathy. That has much more obvious ST-T abnormalities, longer QT, and absence of Q-waves. It would look much more acute. These all look like chronic findings.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88310877082409816692016-03-14T18:24:34.570-05:002016-03-14T18:24:34.570-05:00hello doctor, thank you for these infos,
I have a ...hello doctor, thank you for these infos,<br />I have a small question if I want to differentiate between LV aneurysm and anterior MI,<br />Is it by the other anterior chest leads (v2/v3)? or there is another way Anonymoushttps://www.blogger.com/profile/11725828508030092718noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-33058750264102712662016-03-14T17:21:38.499-05:002016-03-14T17:21:38.499-05:00Wow, so much information packed into one ECG. Thi...Wow, so much information packed into one ECG. This is why I love ECGs, they are often diagnostic if one knows what to look for. <br /><br />Would you say that the inverted Wellens'-like T-waves in V3-V5 are indicative of CNS pathology? <br /><br />Thanks for the great case.<br /><br />DanAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9352345520168033562016-03-14T07:58:27.232-05:002016-03-14T07:58:27.232-05:00Interesting case! Was there any consideration of s...Interesting case! Was there any consideration of stress cardiomyopathy in this patient or a follow-up TTE? Though outside the scope of this case, the cause of his cardiomyopathy seems unclear. I think the neuro cases with abnormal ECG can present a bit of a chicken-or-egg question because CNS events like stroke/seizure have also been associated with myonecrosis and stress cardiomyopathy which can be accompanied with aneurysmal ECG changes. Ali Jazayerihttps://www.linkedin.com/in/majazayerinoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7927213628018469982016-03-13T14:55:19.700-05:002016-03-13T14:55:19.700-05:00Interesting case, which illustrates an ECG that tu...Interesting case, which illustrates an ECG that turned out to reflect LV aneurysm despite no more than minimal ST elevation (and ischemic vs reperfusion T waves in V3-V5).<br /><br />I’d make a few points about this tracing while raising an additional question. First, the prominent notching in the S wave in V2 in association with no more than minimal ST elevation suggests whatever transpired is not acute. It would be all-too-easy to overlook the fact that there IS an Q wave in lead V3, if one did not look lead-to-lead at how the QRS evolves over the course of the precordial leads. This Q in V3 IS significant — as it just should NOT be there (esp. given lack of lateral chest lead Q waves in V5,V6 which is where “septal” q waves normally lie). Thus there are abnormal Q waves not only in V1,V2 — but also in V3.<br /><br />I suspect there may be some lead malposition however, as transition between the QRS picture we see in leads V2-to-V3 is quite abrupt. Nevertheless, prior anterior infarction is likely.<br /><br />My question in a patient who presents with new onset stroke symptoms but no chest pain is whether instead of LV aneurysm — this ECG might not have reflected a fairly recent (but not “acute” ) anterior infarction that may have occurred days-to-a-week-or-two earlier? The Echo (and perhaps additional history) helped to sort out the differential in this case and prove LV aneurysm as the source of this ECG picture — but I would think this tracing might be equally representative of a recent infarction stage prior to aneurysm formation …<br /><br />Finally, I’ll add the thought that ~ 2% of acute infarctions may present as stroke (a bit more or less as I understand, depending on definitions and site) — so in addition to looking for site of emboli in a patient who presents with stroke but no chest pain — the ECG may help identify the small-but-important percentage of acute stroke patients with acute MI.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com