tag:blogger.com,1999:blog-549949223388475481.post5158048628777928306..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Are these Wellens' waves?Unknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-88135782977499472842018-03-22T04:08:13.620-05:002018-03-22T04:08:13.620-05:00Wow... Prof Ken Grauer.... I think I have just bec...Wow... Prof Ken Grauer.... I think I have just become so much smarter by reading your comments.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90498715730040854772018-03-20T09:45:05.712-05:002018-03-20T09:45:05.712-05:00The link to Dr. Walsh's article seems to be br...The link to Dr. Walsh's article seems to be broken. Try: http://www.ajemjournal.com/article/S0735-6757(18)30126-8/fulltextAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53628717193854171352018-03-18T08:23:25.394-05:002018-03-18T08:23:25.394-05:00No. If Wellens' is due to a proximal LAD occlu...No. If Wellens' is due to a proximal LAD occlusion (but not mid-LAD) that reperfused, there will be T-inversion in aVL as well as precordial leads, if that is what you mean.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-92191615193327222782018-03-18T05:19:35.827-05:002018-03-18T05:19:35.827-05:00Sorry; little correction..... I ment T wave... Sorry; little correction..... I ment T wave... MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80942113596536733552018-03-17T15:06:57.732-05:002018-03-17T15:06:57.732-05:00GREAT case that illustrates a number of important ...GREAT case that illustrates a number of important points about lead placement. As per Drs. Smith & Walsh, the most probable reason for the change in ST-T wave appearance in lead V2 is a change in electrode lead placement for the reasons stated in this post. I’d add that even if electrode lead position was accurate in the 1st ECG — that the biphasic (pos-neg) ST-T wave in V2 would still most likely be part of the early repolarization pattern, in which lead V2 here simply reflects TRANSITION between the prominent negative T wave from V1 — to the prominent positive T wave in V3 in this patient with marked repolarization changes. Upward sloping ST segment concavity (ie, “smiley”-configuration) plus prominent J-point notching in numerous leads all strongly support this being a repolarization variant. The rhythm is interesting. Lack of a clear upright P wave in lead II in the 1st ECG (no upright P is seen in any of the 6 beats of the long lead II) — tells us that the mechanism of the rhythm in the 1st ECG is not sinus. The presence then of an upright P wave in leads I and aVL + a neg P in lead III confirms this to be a low atrial or coronary sinus rhythm. Then in the 2nd ECG — IF you focus on the long lead II rhythm strip — you will see a CHANGE in P wave morphology (ie, there is a tiny positive deflection in front of the 2nd QRS in ECG #2, and then a somewhat larger P in front of the 3rd QRS complex — but P waves are absent in front of all other beats!). Given the gradual change in R-R intervals over the course of this long lead II rhythm strip — this most likely reflects a wandering atrial pacemaker (which is a common normal variant rhythm in a young adult without underlying heart disease). So as per Drs. Smith/Walsh — the reason P waves in leads V1, V2 in the 1st ECG do not have a negative component despite almost certain placement 1 or 2 interspaces too high — is that the P wave is not arising from the SA node. Final Point — In addition to the presence of an r’ and P wave negativity in V1, V2 — the appearance of a QRS complex in V1, V2 that looks very similar to the QRS in lead aVR is another clue that the V1, V2 electrodes were probably placed too high when ECG #1 was recorded (Note the QRS in leads V1, V2 looks very different compared to that for the QRS in lead aVR in ECG #2, in which presumably electrode lead placement is more accurate). So, I’d add a 4th LEARNING POINT: Always begin the interpretation of ANY 12-lead ECG by spending the 2-3 seconds it takes to perform an “educated look” at a simultaneously-obtained long lead II rhythm strip. Do this BEFORE you look at the rest of the 12-lead. You’ll be AMAZED by how doing so will pick up otherwise too-easy-to-overlook changes in the rhythm. And if you do not see an upright P wave in the long lead II — then you KNOW that the mechanism of the rhythm is not sinus. THANKS to Drs. Smith and Walsh for presenting!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61877410962119830912018-03-17T13:23:33.884-05:002018-03-17T13:23:33.884-05:00It just means that the bulk of atrial depolarizati...It just means that the bulk of atrial depolarization is towards aVLSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40403557554757598332018-03-16T23:21:34.757-05:002018-03-16T23:21:34.757-05:00Thank you..
Any significance of upright P wave in...Thank you.. <br />Any significance of upright P wave in lead aVL? MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.com