tag:blogger.com,1999:blog-549949223388475481.post4247036715280496265..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: New Paper published on Significance of Reciprocal ST depression in lead aVLUnknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-549949223388475481.post-6174020348570989442015-11-17T13:18:21.651-06:002015-11-17T13:18:21.651-06:00Well, it is not really QRS distortion because it i...Well, it is not really QRS distortion because it is normal to have neither a J-wave nor an S-wave in lead V4. However, even if that were abnormal for V4, this one has a J-wave in V4! So even if V3 looked like V4, it would not be QRS distortion because there is "either a J-wave or an S-wave." in this case there is a J-wave, but no S-wave. So V3 can look like that. Again, V4 can have NEITHER and be normalSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-244028976941155882015-11-17T11:58:06.979-06:002015-11-17T11:58:06.979-06:00Dear Smith
Do you mean that there is indeed QRS di...Dear Smith<br />Do you mean that there is indeed QRS distortion in V4 in figure C? and If I see V4 QRS distortion in other ECG, it is normal?<br />thanksAnonymoushttps://www.blogger.com/profile/04027074336621847237noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6386216551541644332015-11-17T10:43:50.049-06:002015-11-17T10:43:50.049-06:00Terminal QRS distortion is normal in V4. It is on...Terminal QRS distortion is normal in V4. It is only if it is in either V2 or V3 that I get worriedSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25905368650271319722015-11-17T10:42:53.701-06:002015-11-17T10:42:53.701-06:00Dear Smith
dose the V4 in figure C show terminal Q...Dear Smith<br />dose the V4 in figure C show terminal QRS distortion? ThanksAnonymoushttps://www.blogger.com/profile/04027074336621847237noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41730360434375949222015-11-06T15:25:34.727-06:002015-11-06T15:25:34.727-06:00CONGRATS on publication of your article Steve! NIC...CONGRATS on publication of your article Steve! NICE to get a “formal study” out there on this important subject! I’d just add 2 points: i) In the ECG shown in Figure A — there IS T wave inversion, but NO ST depression (as you emphasize). It is key to be aware of the difference. Isolated T wave inversion may be normally seen in lead aVL, especially when the QRS is predominantly negative (as it is in Fig. A). So Figure A truly supports your emphasis that this is not a stemi tracing.<br /><br />Point ii) — The easiest way I’ve found to explain the concept of reciprocal ST-T depression is to think of a “mirror-image”. Leads III and aVL are almost “magic” in how with acute occlusion, the two leads so often manifest a mirror-image of the other. We see this in Figure B — for which the tiny amplitude complex in aVL manifests an ST-T wave that truly looks (shape-wise) like the mirror-image of the ST-T wave that we see in lead III.<br /><br />THANKS again for your work on this subject Steve!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com