tag:blogger.com,1999:blog-549949223388475481.post5111988251510734394..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Inferior hyperacute T-waves and ST elevation. Angiogram is normal. What happened?Unknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-60989506323711324542014-07-24T15:33:21.987-05:002014-07-24T15:33:21.987-05:00It would be inferior wall: probably RCA, possibly ...It would be inferior wall: probably RCA, possibly circ. Spasm is possible. More likely is ulcerated plaque with thrombus that later lysed. Or both. ACS with plaque rupture often causes spasm.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85139604572654773192014-07-23T07:51:54.119-05:002014-07-23T07:51:54.119-05:00This is prizmetal angina and t wave depression in ...This is prizmetal angina and t wave depression in avl supports spasm of lad.Anonymoushttps://www.blogger.com/profile/16218268439781983452noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72207443673877182782012-06-15T09:28:18.504-05:002012-06-15T09:28:18.504-05:00The diffuse ST elevation is not upwardly concave, ...The diffuse ST elevation is not upwardly concave, which one would see in pericarditis. And there is not, as you say, ST elevation in I and aVL. There is much less than 1 mm ST depression in V5 and V6, and it takes almost 1 mm for this to be a specific finding (and the studies on this are very old and of poor methodology, Spodick et al.). This ECG is clearly diagnostic of inferior injury.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-56939056404485193362012-06-15T08:44:18.913-05:002012-06-15T08:44:18.913-05:00And there is also a PR segment depression 1 mm in ...And there is also a PR segment depression 1 mm in V5-V6.Fran Mirhttps://www.blogger.com/profile/17031603490263909648noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64354477374488845022012-06-15T08:31:42.012-05:002012-06-15T08:31:42.012-05:00In this EKG there is a diffuse upsloping ST segmen...In this EKG there is a diffuse upsloping ST segment elevation in II,III, AVF,V3-V6. Because of the age of the patient I would do an bedside echo. If there were ST elevation in I, AVL I would think that was an acute pericarditis.....Fran Mirhttps://www.blogger.com/profile/17031603490263909648noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38295756701710517292012-04-06T12:33:40.982-05:002012-04-06T12:33:40.982-05:00Yes, there is STE in V4 as well. I think V3 is ba...Yes, there is STE in V4 as well. I think V3 is baseline STE for a young man. I agree that there is ST depression in V1 and probably a posterior MI as well. Additionally, there is an isoelectric ST segment in V2, when it should probably be a bit elevated, so this lead too is manifesting posterior MI. Any ST depression due to posterior STEMI is "reciprocal": it is reciprocal to the ST elevation that one would find if there were leads on the posterior wall.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47764953061739301922012-04-06T12:21:22.558-05:002012-04-06T12:21:22.558-05:00You mention STE in V5 and V6, but not V4 or V3. To...You mention STE in V5 and V6, but not V4 or V3. To my eye there is also STE in V4 and (to a lesser extent) V3 unless I am missing something?<br /><br />Also I'm still trying to wrap my head around posterior changes in a standard 12-lead when there is fairly extensive STEMI elsewhere, is V1 suggestive of posterior STEMI or could it be attributed to reciprocal changes?<br /><br />Cheersakroezehttps://www.blogger.com/profile/08672077465468282006noreply@blogger.com