tag:blogger.com,1999:blog-549949223388475481.post7849270422812384188..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: LAD occlusion in the setting of paced rhythmUnknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-549949223388475481.post-23885865870046428782014-02-05T06:42:43.384-06:002014-02-05T06:42:43.384-06:00I'm using the modified Sgarbossa criteria. Se...I'm using the modified Sgarbossa criteria. See my paper on the right-hand side from annals of emergency medicine.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3934651773794000802014-02-05T01:51:40.066-06:002014-02-05T01:51:40.066-06:00In V1 V2 V3 remember Scarbossa's Criteria for ...In V1 V2 V3 remember Scarbossa's Criteria for the hidden MI ; / <br />Dr. Jameshttps://www.blogger.com/profile/18292750728401164588noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85814991502660977052011-01-07T08:24:16.598-06:002011-01-07T08:24:16.598-06:00Yes, there is concordant ST elevation in aVR. But...Yes, there is concordant ST elevation in aVR. But this was not a left main issue. Which points out what I have stated before which is that ST elevation in aVR is not specific for left main ACS. In my view, the literature on this is not particularly good: it does not show whether STE in aVR is independently predictive of left main (independent of STE in V1, or widespread ST depression), and there is no good data to show its sensitivity and specificity. <br /><br />In general, if STE in aVR is greater than STE in V1, that is a better predictor of Left Main occlusion. Also, if there is STE in aVR and aVL (both), that is also better.<br /><br />Amal Mattu states these are both highly specific. I'd like to know which paper(s) he bases this on and read them again. I have yet to see a convincing study that these findings are highly reliable, and, as far as I can tell, I've read them all.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-4466924116834827672011-01-06T16:55:54.480-06:002011-01-06T16:55:54.480-06:00This ecg also seems to show STE in aVR, but it is ...This ecg also seems to show STE in aVR, but it is difficult to tell on my computer screen. <br />Would you agree? <br />My understanding is STE in aVR is associated with occlusion of the left main coronary artery and carries a very bad prognosis, so could this have been used, in addition to the criteria you presented, when talking to the cardiologist?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35638034421896691922010-12-22T12:17:10.884-06:002010-12-22T12:17:10.884-06:00I have encountered similar situations where subtle...I have encountered similar situations where subtle EKG findings, especially in setting of BB or paced rhythm, are not often appreciated by cardiologists. It seems we in the EM community are often more up to speed on this than our cardio colleagues.Andrewhttps://www.blogger.com/profile/04062124855639539500noreply@blogger.com