tag:blogger.com,1999:blog-549949223388475481.post3108659890221735654..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical contextUnknownnoreply@blogger.comBlogger28125tag:blogger.com,1999:blog-549949223388475481.post-32084661403757915492017-04-11T12:06:28.353-05:002017-04-11T12:06:28.353-05:00We can often reliably diagnose STEMI in the presen...We can often reliably diagnose STEMI in the presence of tachycardia. We just have to be careful and smart about it. The decisions are not simple. You must think of all the possibilities and how to approach solving the problem.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57834653596884966512017-04-05T05:06:36.715-05:002017-04-05T05:06:36.715-05:00Can sinus tachycardia cause ST seg changes in the ...Can sinus tachycardia cause ST seg changes in the absence of MI?? If yes than can we reliably diagnose STEMI in the presence of tachycardia or do v need to control the rate and re-read the rhythmMGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75958584377278723042016-07-08T08:29:04.842-05:002016-07-08T08:29:04.842-05:00Sorry, do not understand questionSorry, do not understand questionSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-26840466385079159242016-07-01T12:26:40.281-05:002016-07-01T12:26:40.281-05:00
06/28/16 On 06/27/16 Sinus rhythm to sinus tachy... <br />06/28/16 On 06/27/16 Sinus rhythm to sinus tachycrdia up to 166 bpm. During tachycardia, ST depression and others with out st ..sinus rhythm to sinus tachycrdia 160 what does this meanCynthiahttps://www.blogger.com/profile/11570947731799614948noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68617878009940468982014-10-27T08:28:27.934-05:002014-10-27T08:28:27.934-05:00We have studied it in our paramedics for specific ...We have studied it in our paramedics for specific problems and they do very well. Of course it could be done. The issue will be cost, as it is in everything!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53706515879992656962014-10-27T08:24:46.988-05:002014-10-27T08:24:46.988-05:00Do you think that bedside echo (used in this capac...Do you think that bedside echo (used in this capacity) would ever be available in the prehospital field? Thanks. Anonymoushttps://www.blogger.com/profile/18222904329664397307noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39673439621825439562014-10-27T05:29:03.991-05:002014-10-27T05:29:03.991-05:00I just want to say I love looking at the ecgs, rea...I just want to say I love looking at the ecgs, reading the cases, and discussion that come up afterwards. It makes it even more interesting when there is some debate! Thanks TrentAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57851126138972062312013-06-03T15:07:16.023-05:002013-06-03T15:07:16.023-05:001. In this case, we don't even know if there e...1. In this case, we don't even know if there ever was reperfusion of the RCA.<br />2. Reperfusion gives inverted T-waves during the peri-infarct period. Over time these become upright.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61561244378030688622013-06-03T15:01:52.383-05:002013-06-03T15:01:52.383-05:00How about the upright T wave in inferior leads ins...How about the upright T wave in inferior leads instead of inverted one? Shouldnt they be inverted if reperfusion occurs?Ryanhttps://www.blogger.com/profile/07887913972435356137noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85808411710792409822013-06-03T14:28:29.626-05:002013-06-03T14:28:29.626-05:00Ryan,
1) yes, previous inferior MI, yes it does lo...Ryan,<br />1) yes, previous inferior MI, yes it does localize<br />2) it is an inferior (not anterior) aneurysm<br />3) Exactly. And inferior aneurysm does have reciprocal ST depression<br />thanks,<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14737088576198467252013-06-03T14:08:38.879-05:002013-06-03T14:08:38.879-05:00Great post even though it was some years ago..Some...Great post even though it was some years ago..Some questions though:<br />1) Does Q wave in lead III mean that it was a previous inferior MI? In other words, does Q wave ( like STE ) localize?<br /><br />2) If so, why did the Q wave localize to inferior leads instead of V1-V3 ( QS pattern ) if it was a LV aneurysm<br /><br />3) There are T wave inversions in lateral leads with ST depression in high lateral leads and with that ST elevation in inferior leads, could the aneurysm be localized anatomically in the inferior wall of the left ventricle?<br /><br />Ryanhttps://www.blogger.com/profile/07887913972435356137noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-913072963336265382013-04-13T12:06:13.749-05:002013-04-13T12:06:13.749-05:00Same way you determine QRS axis. It will be perpe...Same way you determine QRS axis. It will be perpendicular to any isoelectric ST segment, and in the direction of the ST segment of highest voltage. It is a bit hard to explain in writing without demonstrating. If there is ST depression in I, II, V4-V6, and ST elevation in aVR, the ST elevation axis is towards aVR and diametrically opposite those leads with ST depression. In this latter case, the primary disorder would be subendocardial ischemia manifesting as ST depression in inferior/lateral leads, with reciprocal ST elevation in aVR. Think about it!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87185684439936664912013-04-12T16:12:25.359-05:002013-04-12T16:12:25.359-05:00How do you determine the st axis? How do you determine the st axis? Travishttps://www.blogger.com/profile/12784677165489402715noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81834500467486157382013-03-11T13:49:14.108-05:002013-03-11T13:49:14.108-05:00Ana, Good question. There should always be a wall...Ana, Good question. There should always be a wall motion abnormality, and, in fact, more than that: there will often be diastolic dyskinesis and there should always be at least wall thinning. It was not seen in this case probably because 1) bedside ultrasound was not done with the same quality imaging, machine, Definity contrast and 2) tachycardia makes it much harder to evaluate.<br /><br />Steve Smith Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12910116397984994822013-03-10T13:30:13.661-05:002013-03-10T13:30:13.661-05:00Shouldn't the old inferior MI have been visibl...Shouldn't the old inferior MI have been visible on echo? Or is it possible to only have an "electric scar" with aneurysm morphology?Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18198946309580437882011-04-27T20:25:15.883-05:002011-04-27T20:25:15.883-05:00Yes, just as it does in this case.Yes, just as it does in this case.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44038041387070624762011-04-27T16:26:55.532-05:002011-04-27T16:26:55.532-05:00does ST elevation caused by LV aneurysm make recip...does ST elevation caused by LV aneurysm make reciprocal ST depression??Kostehttps://www.blogger.com/profile/10080592850323840751noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63120113430546871822011-01-17T18:41:30.502-06:002011-01-17T18:41:30.502-06:00Yes, that may help if anxiety is really the etiolo...Yes, that may help if anxiety is really the etiology of the tachycardia, which it only commonly is in intubated patients who are not adequately sedated; then lorazepam or propofol are useful.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65042824771235634802011-01-17T10:47:13.797-06:002011-01-17T10:47:13.797-06:00So if pain does not cause tachycardia and anxiety ...So if pain does not cause tachycardia and anxiety increases HR increasing 02 demand would it be more appropriate to consider Valium or Ativan over the traditional morphine?Lungshttps://www.blogger.com/profile/04531209736682979225noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68750539176903840732010-10-31T21:06:25.069-05:002010-10-31T21:06:25.069-05:00No, this does not apply to atrial fib. I should h...No, this does not apply to atrial fib. I should have specified that I mean sinus tach.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74786114776050697742010-10-31T12:25:03.436-05:002010-10-31T12:25:03.436-05:00Even when the rhythm is atrial fibrillation?Even when the rhythm is atrial fibrillation?Tom Bhttps://www.blogger.com/profile/18291404904437933272noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85725178973247119852010-10-28T08:45:58.758-05:002010-10-28T08:45:58.758-05:00I have a box of 355 consecutive LAD occlusions rig...I have a box of 355 consecutive LAD occlusions right next to me. The only ones with tachycardia had shock. There are now 3 studies proving that pain does NOT cause tachycardia. Anxiety does cause tachycardia, but these patients are usually calm (although with a look of doom) unless they are in shock (decreased brain perfusion).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16517763120374856622010-10-28T03:00:04.482-05:002010-10-28T03:00:04.482-05:00Very intersting !! i think tacycardia can occur wi...Very intersting !! i think tacycardia can occur with STEMI even without signs of cardiogenic shock, consider the crushing sternal pain is very stressful to the patient and usually patients with MI are anxious which provoke tachycardia , am i right !!Hillishttps://www.blogger.com/profile/17185015147347426255noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64408593291329722872010-10-27T09:15:55.041-05:002010-10-27T09:15:55.041-05:00I don't see any definite signs of the hyperkal...I don't see any definite signs of the hyperkalemmia on the ECG. The QRS is normal (computer read it at 85 ms, and I think that's right. The PR is normal (180ms). You might say that the T-wave in lead III is peaked, but uncertain. In any case, the patient was immediately treated for hyperK because the level was so high. I suspect, with a Cr of 13 (baseline 2.6), that this was a very gradual increase in the K level, and thus the EKG findings (and corresponding danger of hyperK) were minimal.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72029899110032948412010-10-27T08:26:21.068-05:002010-10-27T08:26:21.068-05:00If I'm not terribly mistaken, the K level is a...If I'm not terribly mistaken, the K level is at the cusp of STE and widening QRS (6.9-7ish). This pattern is also similar to that sometimes seen in DKA, which falls more in line with this patient's presenting vitals than I would -expect- to see in a STEMI.Anonymousnoreply@blogger.com