tag:blogger.com,1999:blog-549949223388475481.post2971497461785095084..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: A female in her 60s with sudden chest pressureUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-549949223388475481.post-78591628944882172292019-12-19T09:49:33.972-06:002019-12-19T09:49:33.972-06:00@ Unknown — Our pleasure! — :)@ Unknown — Our pleasure! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46319266313750213922019-12-19T08:19:28.047-06:002019-12-19T08:19:28.047-06:00Thank you very much for case, explanations and com...Thank you very much for case, explanations and comments<br /> Hasmikhttps://www.blogger.com/profile/16653447180857205258noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43860890342559662232019-09-28T22:38:41.872-05:002019-09-28T22:38:41.872-05:00Thank you (as always!) Jerry for your insightful c...Thank you (as always!) Jerry for your insightful comments! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77954552372408954882019-07-16T21:02:45.091-05:002019-07-16T21:02:45.091-05:00Excellent case with discussion by Dr. Meyers and g...Excellent case with discussion by Dr. Meyers and great commentary by Dr. Grauer.<br /><br />Basolateral MIs are among the worst for not showing typical signs of STE or even hyperacute T waves. Many times there is a transmural infarction with no signs on the ECG. I agree with Ken that, in the right setting, ST depression in V1 - V3 is sufficient for diagnosis and V7 - V9 are not necessary. Just be careful that you understand the difference between an ACUTE lateral (formerly "posterior") MI and a SUBACUTE or otherwise completed MI. In his groundbreaking paper that showed that we could indeed diagnose "posterior" MIs on a 12-lead ECG, Dr. Perloff described what a posterior MI should look like: "tall R wave in V1 with flat ST depression and an upright T wave." Unfortunately, what he described was a completed, post-reperfusion artery (turned "right-side up," it would actually represent a large Q wave, still some STE with inverted T waves). In the acute setting, a lateral (formerly posterior) MI will often begin with wide and deeply inverted T waves (upside-down hyperacute T's), then flat or downward sloping ST depression (STE) and inverted T waves (pre-reperfusion T waves).<br /><br />Why do we have no inferior wall involvement? Probably because 85 - 90% of the time the LCx is not the major supplier of circulation to the inferior wall (i.e., it is non-dominant). But make no mistake - even when it is non-dominant - the LCx supplies 15 - 25% of the inferior wall of the left ventricle! We usually don't see a problem with this during LCx occlusions (as in this patient) because the RCA is supplying blood and 80% of the time the LAD is also supplying blood to the inferior wall.Jerry W. Jones, MD FACEPhttps://www.medicusofhouston.comnoreply@blogger.com