tag:blogger.com,1999:blog-549949223388475481.post5816653375954231602..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain in a middle-aged maleUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-77067904427338709712014-04-23T07:56:39.584-05:002014-04-23T07:56:39.584-05:00It is not known for certain, but I would not be su...It is not known for certain, but I would not be surprised if most or all of de Winter's T-waves, if monitored for hours, eventually develop ST elevation. But perhaps not. you would have to wait and keep recording in order to find out and that would not be advisable!<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80277395596646733602014-04-22T23:50:52.104-05:002014-04-22T23:50:52.104-05:00Dr. Smith,
To make a diagnosis of de Winter t wav...Dr. Smith,<br /><br />To make a diagnosis of de Winter t waves, does the upsloping ST depressions have to be static or can they eventually develop into STE.<br />I noticed at his 13hr Ecg there appears to be STE most notably in v3 and v4.<br /><br />I ask because I had a similar case that met the criteria for de Winter T waves on admission and serial ecgs but at about 2 hrs after first Ecg he then developed STE in v4-v5, so it left me wondering was it really de Winter T waves or just a STEMI ecg in evolution.<br /><br />Thank you.<br /><br /><br /><br /><br /><br />SKhanhttps://www.blogger.com/profile/12297107680827484572noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57180544591842589602014-04-17T13:31:18.294-05:002014-04-17T13:31:18.294-05:00Unfortunately, in this case I have no more history...Unfortunately, in this case I have no more history. However, in a middle aged male with typical pain, you already have a solid pretest probability and everything regarding the need for immediate cath lab activation then depends on the ECG.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-21280017439642503092014-04-17T12:43:25.912-05:002014-04-17T12:43:25.912-05:00Not often. There is one case on this post in whic...Not often. There is one case on this post in which it happened: http://hqmeded-ecg.blogspot.com/2009/02/hyperacute-t-waves.html<br /><br />More often, hyperkalemia has right precordial ST elevation (not depression) as in these cases:<br />http://hqmeded-ecg.blogspot.com/2013/06/hyperkalemia-and-st-segment-elevation.htmlSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85745144897564596412014-04-17T07:31:04.681-05:002014-04-17T07:31:04.681-05:00In your experience is it common for DeWinter T wav...In your experience is it common for DeWinter T waves to be mistaken for hyperkalemic changes?akroezehttps://www.blogger.com/profile/08672077465468282006noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46338161526682409122014-04-16T16:14:32.180-05:002014-04-16T16:14:32.180-05:00It could be more interesting if you write a little...It could be more interesting if you write a little more about the patient's history, risk factors and pretest probability, to apreciate the context better . thanks for share your knowledge.Anonymoushttps://www.blogger.com/profile/15287790942139951218noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44754894469002438782014-04-16T08:45:18.351-05:002014-04-16T08:45:18.351-05:00Look at the comment I published on that post!! Th...Look at the comment I published on that post!! There is no good evidence to support this NTTV1. It is very insensitive and nonspecific.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-4382610223247744102014-04-16T08:39:57.924-05:002014-04-16T08:39:57.924-05:00Thanks, now i understand it
Comparing to the previ...Thanks, now i understand it<br />Comparing to the previous ECG, possibly there is NTTV1?<br /><br />http://academiclifeinem.com/tall-t-wave-lead-v1/Ryanhttps://www.blogger.com/profile/07887913972435356137noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14763025019740946812014-04-16T08:35:57.610-05:002014-04-16T08:35:57.610-05:00I have clarified it: But these previous T-waves we...I have clarified it: But these previous T-waves were not upright and hyperacute, as they are here in the top ECG: the T-waves in that first ECG are suspiciously large, and there is some hint of reciprocal ST depression in inferior leads. These findings need aggressive investigation with frequent serial ECGs or immediate echocardiography. They could represent LAD occlusion.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57318524088341895962014-04-16T08:19:20.008-05:002014-04-16T08:19:20.008-05:00Possibly u could clarify this?
' But they were...Possibly u could clarify this?<br />' But they were not upright and hyperacute, as they are here: the T-waves in that first ECG are suspiciously large, and there is some hint of reciprocal ST depression in inferior leads '<br /><br />Which 'they' you are referring to?Ryanhttps://www.blogger.com/profile/07887913972435356137noreply@blogger.com