tag:blogger.com,1999:blog-549949223388475481.post6285312567532885630..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: A 25 year old with Epigastric Discomfort, Worse Supine, Better Sitting Up.Unknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-549949223388475481.post-71525783475412193232016-09-02T11:20:20.526-05:002016-09-02T11:20:20.526-05:00We did not find much of a difference in this betwe...We did not find much of a difference in this between patients with early repol and those with subtle LAD occlusion. It did not add anything to our formula model because its discriminatory power is low and is a covariate with other variables.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-11598141754432681602016-08-31T18:25:57.905-05:002016-08-31T18:25:57.905-05:00This is also an important illustration of loss of ...This is also an important illustration of loss of T wave balance T wave in V1 too tall vs V6 that is often missed. You, Amal Mattu and others have illustrated this point. https://www.aliem.com/2013/tall-t-wave-lead-v1/ and Marriott wrote about this many years ago <br />Manno, et al - upright TV1 is common in patients with significant <br /> atherosclerotic disease of the left circumflex artery and right coronary <br /> artery <br /> + Marriott - if the TV1 is larger than the TV6, suspect anterior and/or <br /> lateral myocardial disease (chronic or acute) <br /> - May be an early marker of impending MI <br /> - A new upright tall TVi (NTTVi) may be a marker of acute cardiac ischemia <br /> + Chung - upright TVi suggests acute cardiac ischemia <br /> + Smith - TVi > TVe suggests acute cardiac ischemia <br /> + Barthwal - TVi > TVs is associated with ischemic heart disease <br /> - 84% specific for ischemic heart disease <br /> - 16% false positives <br /> - The NTTVi may precede other expected ECG changes in acute ischemia <br /> - Be especially concerned when the upright TVi is new and large <br /> [Amal Mattu, ACEP 2008] <br /> I find that this is an often missed finding. <br /><br />Jim Feldmanhttps://www.blogger.com/profile/18363688255433321396noreply@blogger.com