tag:blogger.com,1999:blog-549949223388475481.post5606731756915363107..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Terminal QRS Distortion due to LAD OcclusionUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-77868609626383552013-10-11T07:20:14.027-05:002013-10-11T07:20:14.027-05:00MP - fantastic! Please send the ECGs! dr.smiths....MP - fantastic! Please send the ECGs! dr.smiths.ecg.blog@gmail.com<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-58309372544328923972013-10-11T07:18:13.796-05:002013-10-11T07:18:13.796-05:00Sebastien, you're absolutely right. My mistak...Sebastien, you're absolutely right. My mistake. So the distortion is, by Birnbaum's definition, only in V3. <br /><br />Then proportions alone are what make V2 look so abnormal and distorted. when there is that much ST elevation, it is only normal when there is a lot of QRS amplitude, either large R-wave or S-wave.<br /><br />thanks for your comment!<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23871819093567076182013-10-11T05:47:02.683-05:002013-10-11T05:47:02.683-05:00I understand now. The Rs configuration is what the...I understand now. The Rs configuration is what the lead *should* be - as it had a small q I presumed it was a qR lead. Steve, I've learnt more about the ischaemic ECG from this blog than any other source. Many thanks. As it turns out, just today I was shown an ECG by one of my residents – staff weren't sure if it was early repolarization or a STEMI. No reciprocal ST depression. But there were small q waves in V2-V4 like this ECG, and very clearly in V3, a loss of the S wave. This lady recannalized her vessel spontaneously so we were able to see the difference. I'll send it on to you. At the cath, and without ST elevation, there was a 30% in the mid LAD. The importance for me was in feeling confident that she really had a ruptured plaque with thrombus that ultimately dissolved and therefore guiding more aggressive treatment despite the 'minor CAD'. MPMJ Perrinhttps://www.blogger.com/profile/08177271615863248865noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-66423777917083351492013-10-11T02:15:58.809-05:002013-10-11T02:15:58.809-05:00But V2 doesn't have a qR comfiguration, right?...But V2 doesn't have a qR comfiguration, right?Sebastianhttps://www.blogger.com/profile/17580082381519092396noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41744895366681137752013-10-10T09:00:39.243-05:002013-10-10T09:00:39.243-05:00"Emergence of the J point ≥50% of the R wave ..."Emergence of the J point ≥50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration)"<br /><br />V2: STE is greater than 50% of height of R-wave<br />V3: There is no S-wave and this is a lead where it would be expected.<br /><br />Meets the definition.<br /><br />No?<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-28266118949103000502013-10-10T07:04:21.991-05:002013-10-10T07:04:21.991-05:00I'm sorry, where is the QRS distortion? Aren&#...I'm sorry, where is the QRS distortion? Aren't the S waves preserved for RS complexes and the j points < 50 % for qR? I may be making a silly mistake. MJ Perrinhttps://www.blogger.com/profile/08177271615863248865noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54935265588144990502013-10-09T11:56:07.625-05:002013-10-09T11:56:07.625-05:00More than suspect: it is all but diagnostic.More than suspect: it is all but diagnostic.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83094338775692720452013-10-09T11:50:02.888-05:002013-10-09T11:50:02.888-05:00My way of seeing it - V2 has relatively low QRS vo...My way of seeing it - V2 has relatively low QRS voltage, this coupled with excesive ST elevation and T wave ( in my opinion ) should make u suspect LAD occlusion ( an anterior MI )Ryanhttps://www.blogger.com/profile/07887913972435356137noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-69476716074165464942013-10-09T10:01:57.606-05:002013-10-09T10:01:57.606-05:00Vittorio,
Thanks. (I was vacationing in Vittorio ...Vittorio,<br /><br />Thanks. (I was vacationing in Vittorio Veneto, biking!)<br /><br />About 50% of anterior STEMI have no reciprocal ST depression, in particular, mid-LAD occlusion. Proximal LAD occlusion, because it affects the first diagonal to the high lateral wall, usually results in ST depression in inferior leads. Septal STEMI often has ST depression in reciprocal leads V5 and V6.<br /><br />Thanks,<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49055022883840929162013-10-09T09:48:44.463-05:002013-10-09T09:48:44.463-05:00Welcome back Dr. Smith.
Very interesting post.
Th...Welcome back Dr. Smith.<br /> Very interesting post.<br />The lack of reciprocal ST segment depression can be attributed to the precocity of ECG recording or other mechanism?<br />Thank you.<br /><br />Vittorio MasciulliAnonymoushttps://www.blogger.com/profile/17960307225147640866noreply@blogger.com