tag:blogger.com,1999:blog-549949223388475481.post3485996693508198864..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Are These Wellens' Waves??Unknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-549949223388475481.post-30782613787621085312017-12-20T19:50:14.261-06:002017-12-20T19:50:14.261-06:00Brandon, thanks for the nice words.
Steve SmithBrandon, thanks for the nice words.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72178621598857954042017-12-20T17:46:32.451-06:002017-12-20T17:46:32.451-06:00Thank you for posting this case. As a paramedic I’...Thank you for posting this case. As a paramedic I’ve had ED M.Ds tell me that the up down version were U waves, much to my dismay. Thank you so much for your continued contribution to the free education movement Dr. Smith and all of your contributors. Brandonhttps://www.blogger.com/profile/10551663758964861223noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65830747554697251122017-12-19T05:56:32.195-06:002017-12-19T05:56:32.195-06:00Nice case that clearly shows what Wellen’s ST-T wa...Nice case that clearly shows what Wellen’s ST-T waves are not! As per Dr. Smith — the remarkable finding here is the obviously markedly prolonged QT interval (the QT is almost 2/3 of the R-R interval). In the absence of ischemia/infarction or bundle branch block — the finding of a decidedly long QT interval should immediately prompt a “List” = i) Drugs; ii) Serum Electrolytes (low K+/low Mg++/low Ca++); and/or iii) some CNS catastrophe (stroke; bleed; trauma; tumor; coma, etc) as the most likely contributing causes to a prolonged QTc interval. As per Dr. Smith — electrolyte disorder (low K+/low Mg++) is most likely here, given diffuseness of changes with prominent U waves. In addition to U waves — hypokalemia typically produces ST-T wave flattening and/or slight ST depression. It generally doesn’t produce the deeper T wave inversion that is suggested here in leads V3,V4 — so one couldn’t rule out concomitant ischemia on the initial tracing in this case. That said, the follow-up tracing (when K+ = 3.5 mEq/L) no longer shows T wave inversion — so true ischemia is unlikely to have been a factor. I’ll add a few additional thoughts: i) Although serum K+ in the final tracing = 3.5 mEq/L, which is at the lower limit of “normal” — given that this patient was initially so profoundly deficient of K+, it is likely that body potassium (the vast majority of body K+ resides in the intracellular, not extracellular space) is still depleted. I suspect that the residual ST-T wave flattening that we see in this follow-up ECG might further improve once body K+ stores are fully restored. ii) Rather than “QTc” prolongation — the initial ECG showed a long “Q-U” interval. I suspect in the initial ECG that we have a biphasic T wave, with the U wave fusing imperceptibly with the terminal portion of the positive part of this biphasic T wave.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51642335571019804942017-12-18T08:18:35.800-06:002017-12-18T08:18:35.800-06:00So helpful
Thank you So helpful<br />Thank you Anonymoushttps://www.blogger.com/profile/08392980484679894369noreply@blogger.com