tag:blogger.com,1999:blog-549949223388475481.post3166716284863572502..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Dyspnea and Convex ST elevation, Marked LVH, with Bedside EchosUnknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-26476384587542998522016-07-31T08:07:02.099-05:002016-07-31T08:07:02.099-05:00Pendell,
No. In fact, it is right not to order d ...Pendell,<br />No. In fact, it is right not to order d dimer and CTPA. This patient has a clear diagnosis without thinking of PE.<br />Good question!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14276013041306207212016-07-30T21:35:57.229-05:002016-07-30T21:35:57.229-05:00Dr. Smith,
Thanks for the great post. A non-ECG re...Dr. Smith,<br />Thanks for the great post. A non-ECG related question for my learning concerning case #1: would it be wrong not to have ordered a D-dimer (and also not to have done a CTPA) on this patient? My thinking is either or both: 1) we already have a clear diagnosis of heart failure by all clinical, ECG, and radiographic data, and 2) the patient will need to go back on their anticoagulation anyway, so the diagnosis of recurrent PE and/or DVT would perhaps not change management in this stable patient? Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7476507656878648082016-07-14T07:13:48.097-05:002016-07-14T07:13:48.097-05:00Excellent post that highlights the importance of c...Excellent post that highlights the importance of clinical correlation. As per the title of this blog post — LVH (especially when marked) may be associated with ST segment coving. So although we can’t rule out the possibility of acute coronary syndrome solely from the 1st ECG — the overall picture of this 1st ECG is of marked LVH in a patient presenting with shortness of breath (not chest pain) over 5 days, and a clinical presentation of heart failure. Similarly, in the 2nd case — the clinical presentation is pulmonary. The initial tracing here is again one that defies ruling out an acute event solely on that tracing — but the principal ECG finding (poorly localized ST coving in many leads with some inferior ST depression) in light of the pulmonary presentation (without chest pain) is a clinical picture that strongly suggests treating her asthma as first priority with close follow-up to ensure that no significant cardiac event follows. I am NOT surprised that these eye-catching ECGs in both of these insightful cases did not evolve into an acute cardiac event.<br /><br />I LOVE the term, “ST coving”. It is a picture description that evokes a reproducible ST-T wave pattern on ECG — which Dr. Smith wonderfully illustrates is not specific for acute stemi. While this pattern may reflect acute ischemia, it can also be due to LVH, cardiomyopathy, LV aneurysm, drug/electrolyte effect, or other chronic change. So I often use the term, “ST coving” in the Descriptive Analysis part of my interpretation — and then integrate clinical correlation to formulate my Clinical Impression of what a given ECG is or is not likely to really be showing.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com