tag:blogger.com,1999:blog-549949223388475481.post4503750644289603323..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain and Transient ST ElevationUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-549949223388475481.post-49548939493936759202013-11-08T06:40:28.608-06:002013-11-08T06:40:28.608-06:00First, Wellens' pattern occurs in about 60% of...First, Wellens' pattern occurs in about 60% of reperfusion cases in the studies I mentioned. It is not universal. This may be partly due to the timing of the ECGs in these studies. There may always or often be an intermediate stage of simple ST resolution. We know that ST resolution alone is a common finding of reperfusion. But ECGs are not recorded at 5 minute intervals on everyone! In order to know what happens, and it may be very different in different case, there would need to be continuous serial ECGs.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-91614285977618139542013-11-08T06:35:52.565-06:002013-11-08T06:35:52.565-06:00Dave,
1. I don't know that it is widespread kn...Dave,<br />1. I don't know that it is widespread knowledge, partly because I don't have definitive proof) that Wellens' is the aftermath of occlusion. Furthermore, the artery is open, and as long as you are treating with maximal medical therapy and monitoring for reocclusion with continuous ST segment monitoring, then you're probably ok to wait until daytime hours to do the cath.<br />2. I don't know of anything else that obliterates the S-wave. It is not well studied so is not completely understood. <br />3. If a STEMI with Terminal QRS distortion has early reperfusion, I would expect that S-wave to reconstitute. Again, little solid data on this.<br /><br />Thanks for the great questions.<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19004169137268331772013-11-06T18:00:11.112-06:002013-11-06T18:00:11.112-06:00Dear Dr. Smith, thank you very much for these real...Dear Dr. Smith, thank you very much for these really informative cases, from which I learn a lot.<br /><br />I agree wholeheartedly with your statement regarding development of a Wellens pattern. Yes, I did see several patients in whom a full Wellens pattern emerged just after succesful stenting of their LAD lesions.<br /><br />Still, I am not able to explain the near-normal pattern in the interim ECG, ie, the one before the Wellens one.<br /><br />Mehmet.mkcelenkhttps://www.blogger.com/profile/01271085321741539244noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7656399053239853792013-11-06T14:40:06.944-06:002013-11-06T14:40:06.944-06:00Great case Dr. Smith...
I have a few questions:
R...Great case Dr. Smith...<br />I have a few questions:<br /><br />Regarding the "standard answer" for question 2 being no... If wellens means the artery was previously occluded and reperfused, who is to say it could or would not re-occlude at any second? Because of the implication of at least transient occlusion, I do not understand the "lack of urgency" of the standard answer.<br /><br />Regarding the obliteration of the S wave in STEMI.. Is there any other entity to your knowledge that also obliterate the S wave? Or is the reason that terminal QRS distortion virtually assures STEMI because mimics preserve the S wave?<br /><br />Lastly, I've often seen in wellens' a "return" of the obliterated S wave in addition to the T wave inversion. Is this a feature of Wellens, or is it not consistent in your view?<br /><br />Thank you as always!<br />Dave BDave Bhttps://www.blogger.com/profile/04348546121665459931noreply@blogger.com