tag:blogger.com,1999:blog-549949223388475481.post3041267869791477350..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis?Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-68447947468997190242018-02-11T12:16:56.787-06:002018-02-11T12:16:56.787-06:00It takes more than just V1 and III to raise my sus...It takes more than just V1 and III to raise my suspicion. And the ECG is never used to diagnose PE, only to suspect it. Use D dimer and CTPA.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73159546285283507322018-02-09T04:21:14.693-06:002018-02-09T04:21:14.693-06:00Dr. Smith,
Avid follower of your case studies. In...Dr. Smith,<br /><br />Avid follower of your case studies. In your practice, would the finding of T wave inversion in III and V1 alone in the absence of S1Q3T3 put you on high suspicion for APE? It seems most ER docs I come across only use ECGs for STEMI diagnosis and always go D-dimer followed by CTPA. I would love to see a study with a larger sample size and see if the results were the same. <br /><br />Thanks for the knowledge,<br /><br />Troy HooverTroyhttps://www.blogger.com/profile/01227334538616584664noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12550896356184264812017-02-28T07:49:36.146-06:002017-02-28T07:49:36.146-06:00The most common finding is normal!!The most common finding is normal!!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53472573484976075982017-02-27T09:32:59.655-06:002017-02-27T09:32:59.655-06:00Dear Sir,
We have learnt how specific and sensitiv...Dear Sir,<br />We have learnt how specific and sensitive is the findings of midpraecordial T inversion coupled with inferior lead T inversion in P.E.<br />But is that the commonest ECG finding in P.E?<br />A age old textbooks would say the commonest finding is sinus tach, but I tend to see many P.E without sinus tach.Kenhttps://www.blogger.com/profile/17266588380020804028noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6651120411457485582016-10-02T15:22:31.838-05:002016-10-02T15:22:31.838-05:00Being a Vet surgeon I am a follower of your blog s...Being a Vet surgeon I am a follower of your blog sir good one <br />DR.AMARNATHhttps://www.blogger.com/profile/13445075315250556516noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-86063665262485510872016-04-08T10:22:40.647-05:002016-04-08T10:22:40.647-05:00Again, I think left anterior fascicular blockAgain, I think left anterior fascicular blockSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39868185869310007852016-04-07T00:38:48.633-05:002016-04-07T00:38:48.633-05:00I have seen in several cases in your blog that the...I have seen in several cases in your blog that there is left axis in PE?? Actually, in this case... Why??Doinelhttps://www.blogger.com/profile/13529305662308020795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36063855575527362812013-03-08T17:28:01.383-06:002013-03-08T17:28:01.383-06:00The best data on that comes from the paper by Marc...The best data on that comes from the paper by Marchik et al. (http://www.annemergmed.com/article/S0196-0644%2809%2901285-2/abstract)<br /><br />I describe it in this post: http://hqmeded-ecg.blogspot.com/search/label/pulmonary%20embolism<br /><br />Suffice it to say that RBBB had a positive likelihood ratio of 1.8, but independent of S1Q3T3, precordial T-wave inversions V1-V4, and tachycardia, it was not a predictor.<br /><br />Steve Smith Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-50108935260668199322013-03-08T17:11:18.608-06:002013-03-08T17:11:18.608-06:00Dr Smith,
Do you have a comment on new-onset RBBB ...Dr Smith,<br />Do you have a comment on new-onset RBBB and how to interpret that finding in a patient with symptoms suggesting of PE?<br />/Peter Hammarlund P Hammarlundhttps://www.blogger.com/profile/12795866723817205360noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77048563735458812632013-03-08T15:11:30.737-06:002013-03-08T15:11:30.737-06:00In large pulmonary embolism, the right hear outpu...In large pulmonary embolism, the right hear output is greatly limited by the obstruction, and only through high right sided pressures is there sufficient flow to maintain right sided, and hence left sided, cardiac output. A patient with PE, if he/she needs any pressor, needs an arterial vasopressor to keep BP up (if hypotensive). Nitro will decrease right sided filling pressures, decrease right sided output, and can cause severe hypotension. As for heparin, the ACS dosing is much less than the venous thromboembolism dosing.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16469876200217504842013-03-08T14:44:52.848-06:002013-03-08T14:44:52.848-06:00Hi Doc, quick question from a UK EMT - why could n...Hi Doc, quick question from a UK EMT - why could nitroglycerin and heparin be hazardous in a PE? <br />Big fan of your blog by the way, very informative - I've applied lots I've learnt from it to the field!<br />IanIanhttps://www.blogger.com/profile/16066834308131681212noreply@blogger.com