tag:blogger.com,1999:blog-549949223388475481.post8830188230532286107..comments2024-03-19T02:33:29.499-05:00Comments on Dr. Smith's ECG Blog: ST depression does not localize: 2 cases of "inferior" ST depression diagnostic of high lateral STEMIUnknownnoreply@blogger.comBlogger14125tag:blogger.com,1999:blog-549949223388475481.post-72174764769422783752018-02-14T17:51:36.857-06:002018-02-14T17:51:36.857-06:00Good summary. I would add that V5 and V6 are a bi...Good summary. I would add that V5 and V6 are a bit different than I and aVL: V5 and V6 are more inferior-lateral, whereas aVL is high lateral. Inferior MI from RCA may have lateral branches that result in STE in V5 and V6. In our study of 150 inferior MI, 33 had this (can't remember how many were RCA vs. circ though).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6170144946423027262018-02-14T17:27:03.977-06:002018-02-14T17:27:03.977-06:00Hi there,
I wanted to please ask you to clarify s...Hi there,<br /><br />I wanted to please ask you to clarify some conflicting points regarding lateral infarct localization I’ve been struggling with...<br /><br />In essence;<br />- lateral STEMI results in STE in 1, AVL, v5 and V6. These findings alone could be a lesion affecting diagonal branches of LAD; or a lesion affecting the Obtuse marginal branches of LCx.<br /><br />- usually, STE in these leads is accompanied with STE elsewhere which helps localize: additional anteroseptal involvement suggests LAD; additional inferopostero involvement suggests LCx.<br /><br />- 1, AVL (high lateral) STE without any other findings, is typically D1 of the LAD. But could be OM of LCx.<br /><br />- v5,V6 STE without any other findings is typically OM of LCx. But could be D1 of LAD.Dave Cloetehttps://www.blogger.com/profile/09354966379695467534noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-62539410782759118832016-01-18T20:25:51.824-06:002016-01-18T20:25:51.824-06:00Minimal and very normal to my eye.Minimal and very normal to my eye.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-50490030343978086842016-01-18T12:12:39.943-06:002016-01-18T12:12:39.943-06:00In the Case 1 ECG 1 I see a bit of ST depression i...In the Case 1 ECG 1 I see a bit of ST depression in V4-V6.<br />Is it correct?<br />Thanks.Stilichohttps://www.blogger.com/profile/13908484620668565360noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36575716313311822602015-01-01T08:08:37.529-06:002015-01-01T08:08:37.529-06:00Zainab,
Repolarization voltages (ST-T) should alwa...Zainab,<br />Repolarization voltages (ST-T) should always be proportional to depolarization (QRS) voltages. A small amount of ST elevation in the context of a small QRS is significant. A large amount of ST elevation or depression in the context of high voltate QRS (such as LVH) may not be significant.<br />OK?<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18792818503335160692015-01-01T07:42:54.099-06:002015-01-01T07:42:54.099-06:00can you please clarify the matter of the relativit...can you please clarify the matter of the relativity of the ST depression to the height of the QRS complex...this is new for me...amazing stuff I must sayAnonymoushttps://www.blogger.com/profile/17344376693687957428noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40202149292867643952012-08-20T07:51:33.571-05:002012-08-20T07:51:33.571-05:00I certainly hope so!I certainly hope so!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32046524359898663762012-08-19T23:08:28.907-05:002012-08-19T23:08:28.907-05:00I think that without a doubt this blog might foste...I think that without a doubt this blog might foster quite some future ECG researchers.<br /><br />Regards,<br />SamuelSBhttps://www.blogger.com/profile/03962205867950441895noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76122587873770242422012-08-19T21:24:16.118-05:002012-08-19T21:24:16.118-05:00There's just not enough good research on all t...There's just not enough good research on all this to know. Too Bad. We need more ECG researchers! (There aren't very many of us)<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84606123873142370722012-08-19T19:21:27.896-05:002012-08-19T19:21:27.896-05:00I wonder to what extent the stress testing results...I wonder to what extent the stress testing results can be extrapolated to non stress testing scenarios? Could one hypothesize that Angina-/NSTEMI-patients more often have diffuse coronary disease leading to widespread ischemia when stress tested (maximal flow impaired in many vessels) but still might produce isolated STD in resting conditions and concurrent occlusion (when maximal flow in other vessels suffices)? See case presentation below:<br /><br />http://hqmeded-ecg.blogspot.se/2010/12/st-depression-v2-v4-posterior-leads.html<br /><br />How rare do you think localized ischemia in inferior leads might be compared to an anterior equivalent?<br /><br />Regards,<br />SamuelSBhttps://www.blogger.com/profile/03962205867950441895noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37752335351530997592011-09-25T11:16:34.896-05:002011-09-25T11:16:34.896-05:00Ainsley, I wish I knew why subendocardial ischemia...Ainsley, I wish I knew why subendocardial ischemia does not consistently localize on the ECG. Fortunately, reciprocal ST depression does localize the ST elevation to the opposing lead(s) (opposite wall).<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77411767854082953152011-09-24T11:04:36.926-05:002011-09-24T11:04:36.926-05:00Hi
This is really interesting, what is your theor...Hi<br /><br />This is really interesting, what is your theory as to what is happening?<br /><br />My (simple) understanding was that, akin to infarcts causing regional elevations, a lesion would decrease blood flow distal to it, causing regional ST depression. And that global ischemia was the result of a global decrease in oxygen delivery (e.g. hypoxia/ anaemia/ CO etc)<br /><br />Cheers<br /><br />AinsleyAinsleyhttps://www.blogger.com/profile/05380954148934939245noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60962545070817752312011-01-18T06:08:17.785-06:002011-01-18T06:08:17.785-06:00Based upon stress test data, no subendocardial isc...Based upon stress test data, no subendocardial ischemia reliably localizes on the ECG.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-28232274968073386312011-01-17T23:28:25.556-06:002011-01-17T23:28:25.556-06:00For clarification, is it just inferior ST-segment ...For clarification, is it just inferior ST-segment depression that does not localize subendocardial ischemia, or ST-segment depression in any lead distribution. Thank you.Anonymousnoreply@blogger.com