tag:blogger.com,1999:blog-549949223388475481.post6413514986838039555..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain in an Elderly WomanUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-659648137589336702016-03-07T12:19:44.191-06:002016-03-07T12:19:44.191-06:00I think de winter's is dynamic and a transitio...I think de winter's is dynamic and a transition, not stable. The publication implies otherwise, however.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-92096090885853201692016-03-05T11:12:47.461-06:002016-03-05T11:12:47.461-06:00As to de Winter, it seems that this ECG pattern is...As to de Winter, it seems that this ECG pattern is not so persistent as it appears according to the original paper of the Dutch group. What is your opinion? Many thanks.<br />MarioAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7736046812597243612016-03-05T08:50:27.939-06:002016-03-05T08:50:27.939-06:00Thanks for the feedback, Mario!
SteveThanks for the feedback, Mario!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1506788431609677932016-03-05T08:49:58.325-06:002016-03-05T08:49:58.325-06:00Thanks, Ken! I totally agree:
I believe de Winter...Thanks, Ken! I totally agree:<br />I believe de Winter's T -waves represent a condition of nearly, but not completely, obstructed flow. My guess is that, had we recorded this EKG 10 minutes earlier, de winters T waves would have manifested. After this time, the artery completely closed, and the EKG transitioned from de winters ST depression through isoelectric ST segments (The recorded EKG) to ST elevation. The first EKG is a snapshot of the time between ST depression and ST elevation. I did not write this on the post because it just seemed too complicated for most people.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84569280971333004142016-03-05T08:48:04.408-06:002016-03-05T08:48:04.408-06:00Dan,
I thought you might see that. Excellent!
T...Dan,<br />I thought you might see that. Excellent! <br />Though I, too, saw this, I was slightly reluctant to mention it because it is important when the DDx is early repol vs. LAD occlusion. In this case, without any ST elevation at all, it is hardly early repol. Nevertheless, this absence of S-wave or J-wave is definitely abnormal.<br />Steve<br />Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47812310106498958002016-03-05T04:55:14.434-06:002016-03-05T04:55:14.434-06:00After having seen many your lessons on this blog, ...After having seen many your lessons on this blog, let me say that I have immediately got, if not the diagnosis, at least the fact that the first ECG is worrying. I have seen almost all ECG signs you mentioned.<br />Dr. Smith, I thank you for your teaching and for your fantastic blog and clinical cases!<br /><br />Mario<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63258081558681512752016-03-05T03:21:03.769-06:002016-03-05T03:21:03.769-06:00GREAT case Steve! Before looking at comments by yo...GREAT case Steve! Before looking at comments by you & Salim — my thoughts were that the very fat and disproportionately tall anterior T waves looked similar to what I’ve seen early on with DeWinter T wave tracings. Clearly we do not have the usual depressed J-point take-off, and T waves aren’t as tall as they are once DeWinter is fully developed — but early on DeWinter-type pattern may look like this esp. given: i) clearly abnormal (hyperacute) ST-T wave in aVL and I; and ii) reciprocal ( = mirror-image) ST-T depression in leads III and aVF — so my guess was impending proximal LAD occlusion based on the initial tracing. Against a circumflex lesion (in my opinion) is localization most of hyperacute changes in this tracing to the anterior leads. I especially think of lead aVL as more of an “anterior” rather than “lateral” lead — especially when I see similar changes occurring in other anterior leads … THANKS for posting! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23416743724196493872016-03-04T17:41:16.555-06:002016-03-04T17:41:16.555-06:00Thanks for the great case Dr. Rezaie and Dr. Smith...Thanks for the great case Dr. Rezaie and Dr. Smith. The first thing that caught my eye on the EKG was terminal QRS distortion in V3 on all 3 EKGs you have here, which alone would have had me very worried in the setting of chest pain. Is this correct? <br />Great learning case and great clinical decision making!<br /><br />Dan LeeAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9870590494814097592016-03-04T14:37:53.413-06:002016-03-04T14:37:53.413-06:00Nice! Congrats!!Nice! Congrats!!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55776185725356380122016-03-03T22:14:31.740-06:002016-03-03T22:14:31.740-06:00Just published a case report on ECG findings in ac...Just published a case report on ECG findings in acute first diagonal artery occlusions that reviews some of this literature.<br /><br />Durant E, Singh A, Acute first diagonal artery occlusion: a characteristic pattern of ST elevation in noncontiguous leads,<br />Am J Emerg Med (2015), http://dx.doi.org/10.1016/j.ajem.2015.02.008Deephttps://www.blogger.com/profile/14369097024431912635noreply@blogger.com