tag:blogger.com,1999:blog-549949223388475481.post3037623221405200141..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest Pain in a 61 year old male. Inferior STEMI without inferior ST elevation.Unknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-549949223388475481.post-14290890760648684392013-08-22T11:25:39.028-05:002013-08-22T11:25:39.028-05:00Dave,
Great observation. There are two reasons fo...Dave,<br />Great observation. There are two reasons for a down-up T-wave: 1) reciprocal to reperfusion T-wave 2) the "up" portion is really a U-wave, think hypoK. This one in aVL is reciprocal to reperfusion in III.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-13237305884137090762013-08-22T11:17:49.173-05:002013-08-22T11:17:49.173-05:00Your thoughts are particulary plausible given that...Your thoughts are particulary plausible given that the patient has had a CABG. I don't know his anatomy, but it is conceivable that a graft could perfuse the distal RCA and not the proximal, and that there could be trouble with the graft to the LAD as well. I don't have the cath report. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7100496390952538492013-08-22T09:09:56.023-05:002013-08-22T09:09:56.023-05:00Dr. Smith,
In the post cath ECG, there is now a bi...Dr. Smith,<br />In the post cath ECG, there is now a biphasic T wave in aVL, however it is "down-up", rather than "up-down".<br /><br />Is this reciprocal to the reperfusion T wave you'd see (up-down) in the inferior leads? Although not visible in the inferior leads (much like the ST elevation was), can the reciprocal of reperfusion T waves be visible in aVL?<br /><br />thanks,<br />DavidDave Bhttps://www.blogger.com/profile/04348546121665459931noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-89116885536231501452013-08-21T18:22:59.328-05:002013-08-21T18:22:59.328-05:00There seem to be Wellen's waves in present in ...There seem to be Wellen's waves in present in the lateral precordial leads. Is it possible that the pt has a lesion in his LAD that is the cause of the anterior injury pattern 2nd to a "reverese coronary steal" phenomenom? Caused by blood being shunted from the proximal/mid-LAD to the distal-LAD to make up for the deficit from an occluded RCA?<br /><br />B/c it looks like areas supplied by the proximal RCA are more ischemic(e.g. the STE in R sided leads + the 2nd degree type II SA block + PR seg elevation in aVR and V1 possibly indicating an atrial infarction) than areas that are supplied by the distal RCA. znelsonhttps://www.blogger.com/profile/17489680782060931321noreply@blogger.com