tag:blogger.com,1999:blog-549949223388475481.post603383517146636692..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: I was reading a stack of ECGs yesterday, and saw this one, with no clinical information....Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-90496275672280389982014-12-19T13:20:24.452-06:002014-12-19T13:20:24.452-06:00Ah, but the ECG is diagnostic.
You are not awar...Ah, but the ECG is diagnostic. <br /><br />You are not aware of the findings that make it diagnostic because this is a new idea that has been tested: both derived and validated in this study: <br /><br />http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064412001606.pdf<br /><br />It takes an open mind to realize that you have never known of this finding. There are new things to discover in ECG interpretation.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9338407579025582852014-12-19T12:42:03.220-06:002014-12-19T12:42:03.220-06:00Apart from long qt the progression of r wave is la...Apart from long qt the progression of r wave is late and the axis is left ward.I am not able to appreciate lad on ecg.but patient is symptomatic.we immediately go for an echo but stubbornly standing for ecg.which is not diagnostic here.Anonymoushttps://www.blogger.com/profile/16218268439781983452noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9077356611325710542014-12-15T11:18:06.874-06:002014-12-15T11:18:06.874-06:00Thanks so much for the feedback!
SteveThanks so much for the feedback!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22639278967793660242014-12-15T04:00:30.231-06:002014-12-15T04:00:30.231-06:00Thanks for another great example. Lots to owe to y...Thanks for another great example. Lots to owe to your blog. Am a big fan and had the honour to meet you in person at the SMACC gold conference. Keep posting these pearls Steve!Torquehttps://www.blogger.com/profile/12839259118453961613noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-69608021543021805932014-12-13T01:21:47.755-06:002014-12-13T01:21:47.755-06:00GREAT clinical case that emphasizes the point you ...GREAT clinical case that emphasizes the point you have so often astutely made - namely how subtle-but-real ST-T wave changes in anterior leads may point out acute in-progress LAD occlusion.<br /><br />In addition to “fatter”-(and taller)-than-usual” precordial T waves in this example with the loss of r wave from V2-to-V3,V4 - the inferior leads are also abnormal. The ST segment in each of the inferior leads is STRAIGHT with a hint of ST depression. This same straightening is seen in V5,V6 - and that is NOT normal. In addition - there is slight-but-real ST elevation in lead aVL - and subtle “fattening” of the T wave in lead I.<br /><br />BOTTOM LINE: While none of these changes by themselves is striking - the combination of soooo many subtle-but-real abnormalities is just not normal. And if there was any doubt - a lot at the prior tracing should have removed any doubt because of the obvious change that occurred.<br /><br />MORAL of the STORY: In addition to your wonderful lessons about subtle anterior ST-T wave changes - the ONLY way to compare prior tracings with current ones is to go lead-by-lead. If that would have been done - then it would have been obvious that the T wave peaking seen here IS acute.<br /><br />THANKS for presenting Steve!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-45117971174662101422014-12-12T23:50:16.098-06:002014-12-12T23:50:16.098-06:00Exactly right. Even a mid LAD occlusion can lead ...Exactly right. Even a mid LAD occlusion can lead to a bit of inferior ST depression since the anterior and inferior walls are a bit opposite each other.<br />Good observation, Patrick!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83134432004153707922014-12-12T23:45:22.377-06:002014-12-12T23:45:22.377-06:00Thanks, Pendell!Thanks, Pendell!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51539598173931442652014-12-12T23:44:35.039-06:002014-12-12T23:44:35.039-06:00Thanks, Brooks!Thanks, Brooks!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82674471600938145592014-12-12T14:55:47.465-06:002014-12-12T14:55:47.465-06:00Is there also a mm or two of STd in the inferior l...Is there also a mm or two of STd in the inferior leads and STe in aVL? My first thought was high lateral infarct. But a mid-LAD occlusion would presumably be after the first diagonal.<br /><br />Patrick, medical studentAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8523568694530194162014-12-12T12:27:04.459-06:002014-12-12T12:27:04.459-06:00Thanks for another great example of this ECG on yo...Thanks for another great example of this ECG on your blog. Thanks to the fact that you have posted so many of these now, I (and I suspect many others) are starting to instantly recognize this ECG as a long-time archenemy.Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74480621499889115272014-12-12T11:30:27.870-06:002014-12-12T11:30:27.870-06:00"I am sorry if I repeat myself too often...&q..."I am sorry if I repeat myself too often..."<br /><br />Your blog is probably the best source out there for learning these early and subtle presentations. Please, keep repeating yourself!Brooks Walshhttps://www.blogger.com/profile/16108633682893762401noreply@blogger.com