tag:blogger.com,1999:blog-549949223388475481.post8172525807071517394..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: An 82 year old with syncopeUnknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-15585298432831050002018-01-10T06:33:31.033-06:002018-01-10T06:33:31.033-06:00Just look a the map of segments (links below). Yo...Just look a the map of segments (links below). You can see that segment 5 is posterior, no matter what Bayes de Luna wants to call it. And it is very distinct on the ECG: when there is transmural ischemia, leads on the back (Posterior) show ST elevation and the (anterior) right precordial leads show reciprocal ST depression. <br /><br />https://www.barnardhealth.us/echocardiography/images/2154_51_114-aha-segment-model.jpg<br /><br />http://www.annals.in/articles/2013/16/4/images/AnnCardAnaesth_2013_16_4_268_119175_f28.jpgSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74618864106981397842018-01-09T14:16:27.253-06:002018-01-09T14:16:27.253-06:00Dear Dr Smith : I must apologize for my limited k...Dear Dr Smith : I must apologize for my limited knowledge compared to yours. I am only a family doctor interested in ecg. I found your case very very excelent for first med contact in ACS chain code. Nevertheless when you comment:"infero-posterior- lateral stemi" must we accept that posterior wall exists? <br />I read a few years ago that just posterior wall is not demonstrated...Thank you very much and congratulations<br />Pepserrahttps://www.blogger.com/profile/12751241025128839686noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8345282463695522902018-01-09T04:22:48.279-06:002018-01-09T04:22:48.279-06:00Bayes de Luna's demonstration is academic in t...Bayes de Luna's demonstration is academic in the EKG world. There clearly is a difference between inferobasal infarction (with ST depression in right precordial leads) and lateral infarction. I find his classification does harm to EKG analysis and is not relevant.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65965251497556986502018-01-08T17:18:06.261-06:002018-01-08T17:18:06.261-06:00Dear colleagues
Accordingly with new classificatio...Dear colleagues<br />Accordingly with new classification of affected walls the MI should be reported as inferobasal/lateral STEMI<br />BAYES DE LUNAet al demonstrated with cardioMRI that the dogma of posterior wall cannot be accepted and that tall R in v1+ elevation ST in v5/6 should be reported as lateral instead of posterior. Isn't? Although I am concerned about the message of this magnific case...<br />ThanksPepserrahttps://www.blogger.com/profile/12751241025128839686noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51213474972260070492017-09-13T14:32:16.116-05:002017-09-13T14:32:16.116-05:00>> it is correctly reading more than 1 mm ST...>> it is correctly reading more than 1 mm ST elevation in 2 leads (II and V5), but these are not consecutive leads.<br />It is correctly reading 1 mm ST elevation in V5 and V6. Alexey Rukinhttps://www.blogger.com/profile/10648952895362962043noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35732201320475421012017-08-06T13:19:06.629-05:002017-08-06T13:19:06.629-05:00Thanks, Ken.Thanks, Ken.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77500808963408469262017-08-05T16:49:48.682-05:002017-08-05T16:49:48.682-05:00Nice case, with credit to that medic for picking u...Nice case, with credit to that medic for picking up on subtle ECG findings. I’d add the following thoughts. Reasons why the 1st ECG is definitely not normal include in addition the appearance of lead V2 — which shows clearly abnormal early transition (with a predominant R wave). In the context of an elderly patient with syncope — the T wave in this lead looks taller and broader-than-it-should be. The shape of the ST segment in lead aVF, though tiny in amplitude — is coved. In that context, the T inversion in lead III looks deeper than expected for a simple T wave following QRS vector change. And while lead II doesn’t show ST-T inversion/depression — the ST segment in this lead is flat, yet not flat in any other of the 11 leads. All of changes are admittedly VERY subtle and nonspecific, with the additional problem of not having a prior ECG on this patient with a history of a prior MI — but taken together in the context of an older patient with symptoms that may relate to an acute/recent event — this IS a suspicious tracing that is possibly indicative of something acute and evolving in need of close follow-up. Again — excellent case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55204958875005192452017-07-31T17:17:08.124-05:002017-07-31T17:17:08.124-05:00Shanen, this is what happens in pseudonormalizatio...Shanen, this is what happens in pseudonormalization. With reperfusion, T-waves invert. With re-occlusion, they become less negative and then become upright. Look at all these cases of pseudonormalization: http://hqmeded-ecg.blogspot.com/search?q=pseudonormalizationSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29352881771383580852017-07-31T17:14:45.609-05:002017-07-31T17:14:45.609-05:00Great observations. I don't think the "f...Great observations. I don't think the "fragmented QRS" is meaningful, but your other observations are very keen and probably represent early ischemia.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37602889164866543722017-07-21T07:27:38.641-05:002017-07-21T07:27:38.641-05:00Maarten,
I do them every 15 minutes for at least a...Maarten,<br />I do them every 15 minutes for at least an hour.<br />STeveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53985280223510177752017-07-19T01:34:47.121-05:002017-07-19T01:34:47.121-05:00Is there any protocol about how "serial ECG&#...Is there any protocol about how "serial ECG's" are done? How frequent, and how many?<br /><br />Kind regards,<br />Maarten Van Hemelen<br />IM residentElienchttps://www.blogger.com/profile/15037073754443315144noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44150772326481122762017-07-12T19:58:42.259-05:002017-07-12T19:58:42.259-05:00I don't seem to understand this one. So, when ...I don't seem to understand this one. So, when I see inverted t's I consider ischemia, look for the possibility of it being reperfusion t waves, or just benign. But the T wave becoming less negative in lead III is what made this EKG suspicious for occlusion? This is a tough one to grasp. Anonymoushttps://www.blogger.com/profile/02413841449083692676noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78130021020626404762017-07-12T12:49:41.888-05:002017-07-12T12:49:41.888-05:00Thanks Steve for this new post.
On the first ECG :...Thanks Steve for this new post.<br />On the first ECG :<br />- flat T wave in lead II<br />- subtle up-down T wave in lead III "towers" microQRS<br />- are QRS fragmentation in leads II, III, aVF specific for coronary artery disease even without LBBB ?Gilles Mugniernoreply@blogger.com