tag:blogger.com,1999:blog-549949223388475481.post5248126585924827663..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Subtle Lateral ST elevation. False positive. This diagnosis is hard.Unknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-68694453122502531122021-01-05T17:49:20.148-06:002021-01-05T17:49:20.148-06:00Thanks! Yes, but also on the T-wave, and not just...Thanks! Yes, but also on the T-wave, and not just its height, but its "bulk".Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2992586389602431422021-01-04T05:47:24.646-06:002021-01-04T05:47:24.646-06:00Would be really nice though to see if an algorithm...Would be really nice though to see if an algorithm based on ST/R ratio for lateral ST-elevations would outperform the traditional millimeter criteria.<br /><br />Thank you for a great blog!Børgehttps://www.blogger.com/profile/07143618816302269849noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44298516345794869252016-06-05T11:56:04.610-05:002016-06-05T11:56:04.610-05:00Mark,
The only literature I know of is my own stud...Mark,<br />The only literature I know of is my own studies of early repol, LV aneurysm, LBBB.<br />But there is also literature on "lead strength", especially in relation to stress tests:<br />https://scholar.google.com/scholar?hl=en&q=lead+strength+electrocardiogram+ST&btnG=&as_sdt=1%2C24&as_sdtp=<br /><br />But I don't think it even requires literature. By simple electrophysiology, it is axiomatic that repolarization will be proportional to depolarization, but this is just not well appreciated and recognized. Sometimes simple truths just do not occur to people or penetrate their preconceptions, and we have been so programmed to measure millimeters of ST elevation that the obvious (which is contrary) can seem revolutionary.<br /><br />Physicians are a very conservative group and new ideas, even though obviously true, are hard for them to accept, especially when they contradict textbooks, statements of professional societies, etc.<br /><br />New paradigms to not readily enter the lexicon.<br /><br />Here T/R ratio and ST/R ratio was far better than ST elevation. The formula was immeasurably better than any ST elevation criteria: http://www.annemergmed.com/article/S0196-0644(12)00160-6/pdf<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-91988623680242612832016-06-04T15:12:17.700-05:002016-06-04T15:12:17.700-05:00Dr. Smith,
Here and in other posts I have seen ...Dr. Smith,<br /><br /> Here and in other posts I have seen you comment on the importance of interpreting ST changes in the context of the QRS amplitude. We recently had a case of an inferior STEMI that did not quite meet STE criteria (max elevation was ~ 0.8mm), but the EKG was very low voltage. I looked at the EKG and immediately said inferior STEMI, but when challenging to backup the practice of interpreting the STE in the context of the QRS size, I could not find any literature to support this. The 2001 CHEST article you cite above does not seem to address the issue of what to do with STE that is not large enough to meet STEMI criteria but is proportionally very large relative to the QRS. Is this proportional approach borne out of your experience, or is there also literature to support looking at the ratio of STE to QRS amplitude in the setting of LOW voltage? (I know you and others have looked at such ratios in LBBB, PPM, LVH, and other high voltage states). <br /><br />Many thanks for the outstanding education on your site, and any thoughts you can provide on this issue,<br />Mark Mark Sutherlandhttps://www.blogger.com/profile/11284099580762198782noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-52271908604565513722012-01-06T01:45:55.593-06:002012-01-06T01:45:55.593-06:00Good question. We see this often: serious chest p...Good question. We see this often: serious chest pain with no apparent etiology. Much of it is probably esophageal spasm. Some small amount may be angina in which the angiographer cannot see a lesion (smooth lesion or spasm). Most of these, if they are causing ECG abnormalties, have a positive troponin also and the ECG evolves. And then there is just the mystery of unexplained chest pain!!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79954868032494294812012-01-06T01:18:44.848-06:002012-01-06T01:18:44.848-06:00what sinister medical entity did you guys decide o...what sinister medical entity did you guys decide on that was responsible for her crushing chest pain?Tomhttps://www.blogger.com/profile/01895711321056105465noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59782437530808168182012-01-05T20:16:06.633-06:002012-01-05T20:16:06.633-06:00The coronaries were normal.The coronaries were normal.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46499457219579312492012-01-05T19:23:52.909-06:002012-01-05T19:23:52.909-06:00what was the eventual outcome of case 1/false posi...what was the eventual outcome of case 1/false positive?Tomhttps://www.blogger.com/profile/01895711321056105465noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-70966526635829284352011-12-27T11:41:44.760-06:002011-12-27T11:41:44.760-06:00Dave,
The first one (case 2) has left axis becau...Dave, <br /><br />The first one (case 2) has left axis because of the old inferior MI<br /><br />Case 3 has a left axis deviation (directly vertical), so that would not correlate with the rule you are trying to make, right?<br /><br />Case 4 has an inferior, normal, axis.<br /><br />So I'm not sure there is a rule here, but maybeSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16558715078514539212011-12-27T11:28:16.837-06:002011-12-27T11:28:16.837-06:00Great cases Dr. Smith...
one observation... the &q...Great cases Dr. Smith...<br />one observation... the "subtle" lateral MI ECG's seem to have some left axis deviation, but not much with leads I and II being positive and III negative, while the less subtle lateral MI's have more pathological left axis deviation..<br />is that just a coincidence?Dave Bhttps://www.blogger.com/profile/04348546121665459931noreply@blogger.com