tag:blogger.com,1999:blog-549949223388475481.post531501062937690815..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Two more Cases of Takotsubo Stress CardiomyopathyUnknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-40875907740357347052010-12-23T06:52:05.270-06:002010-12-23T06:52:05.270-06:00That is correct that it is not always possible to ...That is correct that it is not always possible to determine Takotsubo from the ECG. It is not, however, always necessary to do an angiogram. The clinical context (e.g., in these cases, intracranial bleeding) along with a cardiac ultrasound that shows apical ballooning, is sufficient. In addition, the minority of patients with Takotsubo have an ECG identical to STEMI. Some do.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14389393288296170162010-12-22T18:45:55.598-06:002010-12-22T18:45:55.598-06:00It is impossible to determine Takosubo's from ...It is impossible to determine Takosubo's from the ECG. Really the diagnosis is made from shooting an angiogram of the ventricle in the absence if coronary artery disease.Unknownhttps://www.blogger.com/profile/16874607114753711081noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84932660262279861492010-12-21T06:19:55.485-06:002010-12-21T06:19:55.485-06:00V1 may have minimal ST depression, but mostly it i...V1 may have minimal ST depression, but mostly it is baseline wander. As for aVR, it is always opposite the other leads and therefore any ST depression in aVR does not count as reciprocal. only the opposite of aVR (-)aVR is considered a consecutive lead: aVL, I, (-)aVR, II, aVF, III are consecutive.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36800715805778039402010-12-21T03:34:24.283-06:002010-12-21T03:34:24.283-06:00In case one, you mention that there is no reciproc...In case one, you mention that there is no reciprocal depression, however had I seen this patient, I most likely would have been inclined to consider the ST-depression in aVR and V1 as reciprocal signs of a STEMI. What's your take on this, and am I missing something? Thanks for the fascinating cases and and clarifying my interpretation.VinceDhttps://www.blogger.com/profile/14882359489508540203noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61570095327109595882010-12-20T18:04:09.981-06:002010-12-20T18:04:09.981-06:00Indeed, I almost mentioned the similarities to per...Indeed, I almost mentioned the similarities to pericarditis, which include inferolateral ST Elevation, STE greater in II than III, and absence of any reciprocal ST depression anywhere. Good point!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14420018289585419052010-12-20T16:39:54.089-06:002010-12-20T16:39:54.089-06:00In Case #1 the widespread elevation and potential ...In Case #1 the widespread elevation and potential PR elevation in aVR had me consider pericarditis (especially given the tachycardia). Granted, the ST segments don't look like those in pericarditis.<br /><br />If there wasn't elevation in II I likely would not have considered pericarditis. Is the STE in II because of the extent of the SCM?Christopherhttps://www.blogger.com/profile/11415988855392944633noreply@blogger.com