tag:blogger.com,1999:blog-549949223388475481.post5999878359877945090..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Right Bundle Branch Block with ST Elevation in V1?Unknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-35499115501953259972013-02-05T05:22:56.856-06:002013-02-05T05:22:56.856-06:00For the interested, here's another case of pse...For the interested, here's another case of pseudo-septal STEMI, with a nice tracing for comparison after the patient received treatment.<br /><br />http://www.epmonthly.com/whitecoat/2013/01/whats-the-diagnosis-15/Vince Dhttps://www.blogger.com/profile/10636259293820649555noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10141446627189432362013-02-03T15:27:44.264-06:002013-02-03T15:27:44.264-06:00El,
Great question, which I had to think about for...El,<br />Great question, which I had to think about for a moment: we know it's not RBBB because the r and S of rSR" in RBBB should both be narrow, and here they are both wide. So this is not just a rate-related RBBB + hyperK, but hyperK alone.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17168346773855548232013-02-03T14:40:15.266-06:002013-02-03T14:40:15.266-06:00Steve, On the FIRST eKG: How do you know that th...Steve, On the FIRST eKG: How do you know that the RATE (or electrolyte derangement) didn't precipitate a RBBB? Not only is the QRS wide, but there is right axis deviation. Also when I march out the end of the QRS complex it to me doesn't look like ST elevation or depression in the precordial leads, but just the end of the complex. I agree the second 2 eKGS are pretty cool!<br />ELhttps://www.blogger.com/profile/18147487917176413673noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74861989104892365262013-02-03T09:20:21.138-06:002013-02-03T09:20:21.138-06:00Marton, you may be right, but the p-waves you have...Marton, you may be right, but the p-waves you have marked out are very irregular, so I don't think so. I see what you mean about lead III, but, again, I don't think so: they should be more evident in lead II. Cannot say for certain. <br /><br />thanks!<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-48108644876893511112013-02-03T05:07:34.723-06:002013-02-03T05:07:34.723-06:00Dear Dr. Smith!
I also wonder what the rhythm is....Dear Dr. Smith!<br /><br />I also wonder what the rhythm is. As you wrote gradual decline of the rate suggests sinus tachycardia.<br />But as I looked carefully the ECG I found waves that are suspicious of being P waves.<br />I marked them on this:<br /><br />http://kepfeltoltes.hu/130203/EKG_www.kepfeltoltes.hu_.png<br /><br />If they are P waves they do not seem to be linked to the QRS complexes, so I think there is AV dissociation, which is theoretically possible in supraventricular tachycardias that arise in the AV junction.<br />And as far as I know there are nonparoxysmal junctional tachycardias in which the frequency gradually rise and decline.<br /><br />To have a much more complicated case there seem to be flutter waves in lead III...<br /><br />What is your opinion about this, Dr. Smith? Are they only artifacts?<br /><br />Thanks for your answer!Anonymoushttps://www.blogger.com/profile/08292096280571000937noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-86364396520812428662013-02-02T18:09:51.228-06:002013-02-02T18:09:51.228-06:00Well, it' embarrassing that I did not comment ...Well, it' embarrassing that I did not comment on that. It is sinus tach. The little bump just at the end of the large R-wave in V1 is a p-wave. The baseline ECG has an identical upright p-wave. Also, his rate gradually declined with therapy. Without that extra information, however, it would be a difficult diagnosis because it is hard to find a corresponding p-wave in lead II. On the other hand, I also can't find a pattern that would be fully consistent with flutter. <br /><br />Thanks for the great question.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78664626421094794912013-02-02T17:47:23.968-06:002013-02-02T17:47:23.968-06:00What about the rhythm? Is it an atrial flutter wit...What about the rhythm? Is it an atrial flutter with 2:1 conduction? P Hammarlundhttps://www.blogger.com/profile/12795866723817205360noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74588907530892618422013-02-02T12:49:13.990-06:002013-02-02T12:49:13.990-06:00As U've always said: HyperK is the great imita...As U've always said: HyperK is the great imitator on the EKG Nicolas Peschanskihttps://www.blogger.com/profile/07436778751052243538noreply@blogger.com