tag:blogger.com,1999:blog-549949223388475481.post4372917949546943442..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A 50-something year old with typical chest painUnknownnoreply@blogger.comBlogger17125tag:blogger.com,1999:blog-549949223388475481.post-13506907005065782822018-01-22T09:34:19.377-06:002018-01-22T09:34:19.377-06:00Thanks!
There must be one or the other in both lea...Thanks!<br />There must be one or the other in both leads. One can have an S-wave and the other a J-wave. Actually, 90% of early repol cases had an S-wave in both. 100% had an S-wave in V2. 10% had no S-wave in V3 but all had a J-wave.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9584627325720895332018-01-20T02:28:42.840-06:002018-01-20T02:28:42.840-06:00Hey Dr. Smith,
Thanks for all your great lectures...Hey Dr. Smith,<br /><br />Thanks for all your great lectures and the research you do!<br /><br />I'm just hoping you can clarify something for me. I've watched your lectures on subtle LAD occlusion and BER which has made me question how many misdiagnoses I've made and so I'm frantically going through all of these lectures and papers. :)<br /><br />In this post...<br /><br />http://hqmeded-ecg.blogspot.ca/2015/10/best-explanation-of-terminal-qrs.html<br /><br />You state...<br /><br />"In my modification of the rule, I found that it is never seen in early repol. In other words, if you think an ECG represents early repol, there MUST be either a J-wave or an S-wave in BOTH V2 and V3"<br /><br />However, in this post you state this is an example of BER as there is no QRS distortion. We can see an S-wave in V2 but no J wave and a J-wave in V3 but no S-wave. Based on your previous statement, shouldn't BOTH V2 and V3 have either a J-wave or an S-wave to be diagnosed as BER whereas in this example we can only see one of each? Or is it as long as V2 and V3 include either an S-wave or J-wave then it is BER? I'm just confused as to what you consider to be true QRS distortion so I do not incorrectly apply the formula when I use it on my next shift.<br /><br />Thanks! I met a physician who worked with you at the AIME Advanced course recently in Halifax (I believe she was from New Zealand) and she had nothing but glowing things to say about you.Taft Mickshttps://www.blogger.com/profile/12626123594536612456noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-58895880170674059502014-09-13T08:35:36.808-05:002014-09-13T08:35:36.808-05:00And also PR segment depression, which is not hereAnd also PR segment depression, which is not hereSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-42920140273547820622014-09-13T08:35:15.242-05:002014-09-13T08:35:15.242-05:00With pericarditis, you expect ST elevation in II, ...With pericarditis, you expect ST elevation in II, V5, V6. It is also much less common than normal variant. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59968515005507573922014-09-12T21:48:39.848-05:002014-09-12T21:48:39.848-05:00What about pericarditis? Looks like diffuse, conca...What about pericarditis? Looks like diffuse, concave ST elevation without any reciprocal changesDannoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18153004533317434282014-09-11T14:01:21.783-05:002014-09-11T14:01:21.783-05:00It is very difficult and requires lots of experien...It is very difficult and requires lots of experience and expertise. I looked at it and knew immediately that it was not STEMI. Serial ECGs not changing was very supportive. However, I did wake up in the middle of the night and think, "What if I was wrong?"<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44620724544124768482014-09-11T13:56:56.589-05:002014-09-11T13:56:56.589-05:00That is great. Best to assume the worst until pro...That is great. Best to assume the worst until proven otherwiseSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-571760169496033112014-09-11T13:56:17.422-05:002014-09-11T13:56:17.422-05:00Yes, but they are normal U-waves. Good observatio...Yes, but they are normal U-waves. Good observation.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7172185649905238502014-09-11T07:11:44.521-05:002014-09-11T07:11:44.521-05:00Sir, without anyother investigation only on the ba...Sir, without anyother investigation only on the base of ecg can u say that this is not a mi other than early repolarization?? Sheikh iliyashttps://www.blogger.com/profile/07205705977848528507noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88015366256625648402014-09-10T17:51:39.808-05:002014-09-10T17:51:39.808-05:00As a paramedic i would have called this a stemi du...As a paramedic i would have called this a stemi due to the elivation and pt having chest pain. Treat with NY 0.4mg SL till drip is set up. If pt still has chest pain and BP is above 100/systolic and no relief with NY drip then morphine 2mg. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82040545565028280782014-09-10T10:02:15.027-05:002014-09-10T10:02:15.027-05:00Are U waves present in the chest leads?Are U waves present in the chest leads?Stuartnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64679227013447249842014-09-09T20:39:15.017-05:002014-09-09T20:39:15.017-05:00Thank you, SirThank you, SirEqubal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-91146186137098163672014-09-09T11:13:03.937-05:002014-09-09T11:13:03.937-05:00good question. yes. no LVHgood question. yes. no LVHSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-20746180353388576682014-09-08T18:26:32.937-05:002014-09-08T18:26:32.937-05:00Did you performed an echo to r/o LVH ?Did you performed an echo to r/o LVH ?Johnnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-13036299923348041942014-09-08T11:04:10.734-05:002014-09-08T11:04:10.734-05:00this is early repol, and it can fool you. It can ...this is early repol, and it can fool you. It can look a lot like STEMISteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1261741083420366932014-09-07T17:36:30.104-05:002014-09-07T17:36:30.104-05:00the high amplitude of R wave in V4 and the short...the high amplitude of R wave in V4 and the short QTc in the same lead provided me the clue that this not an MI.<br />bornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19542675844197308662014-09-07T02:06:07.193-05:002014-09-07T02:06:07.193-05:00Is there subtle ST elevation in lead I? Up sloping...Is there subtle ST elevation in lead I? Up sloping ST segment in V2 - hyper acute?Equbal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.com