tag:blogger.com,1999:blog-549949223388475481.post8792483489822937231..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Patient with STEMI (-) OMI is now pain free. Is there need for emergent cath lab activation? Unknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-85152190062965768542021-03-27T10:42:43.788-05:002021-03-27T10:42:43.788-05:00Sorry, should not have included V3.Sorry, should not have included V3.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64925406930447284552021-02-28T13:15:21.219-06:002021-02-28T13:15:21.219-06:00Really interesting case as usual.
But sir I reall...Really interesting case as usual. <br />But sir I really find it difficult to see this point: ''The remaining chest leads ( = leads V1, V3 and V4) all show subtle ST segment straightening (BLUE lines in these leads).''<br />They don't look so straight to me, especially V3Ghassen Chikhaouihttps://www.blogger.com/profile/02744117431493596410noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53280530206083311532020-10-07T07:03:04.103-05:002020-10-07T07:03:04.103-05:00Rather than a localized pattern of a reperfusion T...Rather than a localized pattern of a reperfusion T wave inversion in leads V2,V3 and/or V4 — in ECG #1 of today’s case — I see a more generalized pattern of similar-looking ST segment straightening with shallow terminal T wave inversion in leads V4-6 (perhaps ever-so-subtle ST coving). I didn’t think there was T inversion in V3. The inferor leads show a similar picture to that seen in leads V4-V6, with in additional slight ST elevation and reciprocal changes in aVL. Those shallow-but-real T wave inversions in V4-V6 in context with a history of recent chest pain ARE of potential concern — but today’s case suggested potential recent inf-post-lat OMI, but not Wellens.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63127208164163586072020-10-07T02:24:07.455-05:002020-10-07T02:24:07.455-05:00Dear Dr. Smith, looking at the top ECG and present...Dear Dr. Smith, looking at the top ECG and presentation described here the first thing that popped into my head is a subtle Wellen's pattern in V3-V4. It is supposed to be seen in V2-V3 and is indicative of LAD occlusion (which turns out not to be the case here) but are there any works/cases that establish this pain free + biphasic t waves combination outside of the very narrow description of Wellen's? I suppose you thought of it as well because you did link to a case with Wellen's in the learning points section but did not expand about it specifically.<br />Always interesting to read your blog and learn moreMJhttps://www.blogger.com/profile/03639258973126747134noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-9564988649911377082020-10-05T18:22:12.174-05:002020-10-05T18:22:12.174-05:00If you mean an unchanging troponin, that is common...If you mean an unchanging troponin, that is common. Then it rises abruptly after the artery is open because it gets released.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85684242735635475732020-10-05T09:58:39.885-05:002020-10-05T09:58:39.885-05:00Anyone have any additional references that describ...Anyone have any additional references that describe patients who present with 100% occlusion and elevated troponin that remains unchanging prior to cath? I recently had a similar case that sparked debate.C Caldwellhttps://www.blogger.com/profile/13423548266673735036noreply@blogger.com