tag:blogger.com,1999:blog-549949223388475481.post3866565251153500594..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest Pain, LBBB, and a ratio that does not quite meet the Modified Sgarbossa CriteriaUnknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-49940998028451928052017-02-25T02:50:17.906-06:002017-02-25T02:50:17.906-06:00My interpretation (prior to reading what happened)...My interpretation (prior to reading what happened) — was nothing definitive BUT — that there were 3 leads that caught my eye regarding not-quite-normal ECG findings. In addition to the borderline J-point ST elevation in lead V3 that Dr. Smith discusses in detail — I thought neighboring lead V4 suggested disproportionate ST-T wave upright morphology (given modest S wave depth) — and, neighboring lead V5 manifests slight coving in the J-point area that for the last 2 (of the 3) complexes in this lead, seems to be slightly above the baseline. Although the QRS in lead V5 is small in size and fragmented, it nevertheless is primarily upright — and the ST-T wave with typical LBBB should in general be oppositely directed to the positive QRS in V5 as it is in V6. This makes for 3 leads in-a-row ( = V3,V4,V5) that while non-definitive, do show questionable findings … Finally, lead II has a horizontal “shelf” to its ST segment that is just not “normal” — and which could reflect a reciprocal change … None of these findings appeared definitive to me — but with a high-likelihood presentation (ie, a 55-year old smoker with “agonizing chest pain” and LBBB) without possibility of prompt catheterization — the decision to use thrombolytic therapy seems reasonable (and perhaps preferable to waiting for serial changes). Fascinating follow-up tracing and deductions by Dr. Smith on this case! In addition, my bet would be that IF an earlier tracing on this patient showing LBBB had been available — that it would have been revealing and different from what we see in this LBBB tracing. THANKS again to Dr. Smith for presenting this case, and adding insight to astute clinical use of modified Smith-Sgarbossa criteria when the patient presents with LBBB ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39273314235288580172017-02-24T08:42:10.465-06:002017-02-24T08:42:10.465-06:00Ian,
I had intended to mention that. However, Chap...Ian,<br />I had intended to mention that. However, Chapman's and Cabrera's signs are signs of old, not acute, MI.<br />Thanks,<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80962503466156009502017-02-24T08:41:33.614-06:002017-02-24T08:41:33.614-06:00However, Chapman's and Cabrera's signs are...However, Chapman's and Cabrera's signs are signs of old, not acute, MI.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14217856013100166262017-02-24T08:40:43.325-06:002017-02-24T08:40:43.325-06:00The cutoff of 25% is very specific, but only about...The cutoff of 25% is very specific, but only about 80% sensitive. Nothing is perfect!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10487725440279289902017-02-24T08:38:59.508-06:002017-02-24T08:38:59.508-06:00Great question. It is actually Cabrera's sign....Great question. It is actually Cabrera's sign. I had intended to mention that. "Cabrera's sign" is a notch greater than 50 ms on the ascending limb of the S-wave in one of V3-V5. "Chapman's sign" is a notch on the ascending limb of the R-wave in I, aVL, or V6).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14253886533337997462017-02-21T08:01:53.939-06:002017-02-21T08:01:53.939-06:00Doesn't the first ECG also show Cabrera's ...Doesn't the first ECG also show Cabrera's sign? Not very sensitive but in context may have been useful?Anonymoushttps://www.blogger.com/profile/09912975021020183665noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15513127329838072282017-02-20T15:27:54.844-06:002017-02-20T15:27:54.844-06:00sir .
i am getting confused ! once before you said...sir .<br />i am getting confused ! once before you said modified scarbossa validated. but now you decrease the cut of to 19 . what is wrong ?<br />Anonymoushttps://www.blogger.com/profile/12852380081794106666noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27461570054784816772017-02-20T12:55:00.871-06:002017-02-20T12:55:00.871-06:00Thank you doctor for this case.
could the Chapma...Thank you doctor for this case. <br /><br />could the Chapman's sign here be the clue to go with the diagnosis of ACS? Anonymoushttps://www.blogger.com/profile/02799959312612970756noreply@blogger.com