tag:blogger.com,1999:blog-549949223388475481.post5445376691928727913..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: A Young Man with Recurrent Chest Pain and Dyspnea with ExertionUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-68758072089047087662016-12-29T05:19:49.948-06:002016-12-29T05:19:49.948-06:00Echo was not consistent with noncompaction cardiom...Echo was not consistent with noncompaction cardiomyopathy.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29960488467105540512016-12-23T10:47:57.522-06:002016-12-23T10:47:57.522-06:00thanks dr. Smith for this case ,,, but i see that ...thanks dr. Smith for this case ,,, but i see that is a case of noncompaction ventricular myocardium... so, MRI is indicated for this patient , B-blocker is not ideal medication ,an angiotensin-converting enzyme inhibitor may be indicated, several authors have recommended long-term prophylactic anticoagulation for all patients with ventricular noncompaction whether or not thrombus has been found and ambulatory ECG monitoring should be performed annually. <br />thank you sir.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85970996835370250972016-12-02T17:47:01.964-06:002016-12-02T17:47:01.964-06:00Of course! Thank you very much!Of course! Thank you very much!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1213001462546010542016-12-02T14:12:06.234-06:002016-12-02T14:12:06.234-06:00It changes with different patient position or with...It changes with different patient position or with lead placement. But placement of limb leads is not usually very different from time to time, so more likely positionSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8689523296629790612016-12-02T13:52:20.324-06:002016-12-02T13:52:20.324-06:00Ah I didn't think about it that way! So does t...Ah I didn't think about it that way! So does the axis of complexes change slightly in patients at different times normally? Or is the difference in the 2 ECGs due to placement of the electrodes? I understand now how an almost perpendicular axis in lead III is making it a poor lead to look at in terms of LVH. Just the reason for the change in lead III from the first ECG to the 2nd is confusing me. Thanks a ton for replying. I'm mostly self taught through as many books and online sources as I can so sorry if some of these questions are elementary in a sense.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32216694469565059932016-12-02T10:26:39.430-06:002016-12-02T10:26:39.430-06:00The axis is less towards III than towards II. So ...The axis is less towards III than towards II. So III does not get to "see" all that voltage. Similarly, the T-wave axis is perpendicular to III, with the initial phase towards (+) and the later phase away (-). A complex's axis determintes where the voltage is best seen.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83881688629376864142016-11-30T23:11:12.564-06:002016-11-30T23:11:12.564-06:00Thanks for these amazing posts. I have a question ...Thanks for these amazing posts. I have a question about the ECGs. In the 2nd ECG in lead III the QRS voltage is much smaller, there almost looks like STE and the T wave has changed from inverted to biphasic. I notice this is isolated to lead III and there are no other contiguous lead changes (or any leads for that matter) to confirm with so does that mean this is nonspecific changes? Or can this be the only clue of ischemia now in an ECG that is otherwise normally dominated by LVH and strain pattern?Myles Tuchschererhttps://www.blogger.com/profile/13386981715607815505noreply@blogger.com