tag:blogger.com,1999:blog-549949223388475481.post8876955996166769950..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A young woman with epigastric pain. ECG Crochetage sign? What is the significance?Unknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-76303016684153753442021-01-15T04:13:37.095-06:002021-01-15T04:13:37.095-06:00description of notch on R wave in the electrocardi...description of notch on R wave in the electrocardiogram of the patient with atrial septal defect was given by Alvarez et al in 1959.Equbal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-67004476667869705672021-01-15T04:13:30.489-06:002021-01-15T04:13:30.489-06:00description of notch on R wave in the electrocardi...description of notch on R wave in the electrocardiogram of the patient with atrial septal defect was given by Alvarez et al in 1959.Equbal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27974951417137816342020-01-11T15:44:25.399-06:002020-01-11T15:44:25.399-06:00Thanks so much (as always!) for your insight Jerry...Thanks so much (as always!) for your insight Jerry. As I noted in the 3rd bullet of My Comment above — lack of similar notching at the same place in all 12 leads to me argued against artifact (despite other clear artifactual deflections on this tracing within the BLUE circles, and the simultaneously-obtained leads below them in Figure-1). I believe we agree that the diagnosis of an ASD secundum effect can’t be made on the basis of this ECG — but that further eval. is clearly indicated. THANKS again for your comment! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79934809580264895842020-01-11T11:31:55.701-06:002020-01-11T11:31:55.701-06:00Steve and Ken...
I think this sign is more consis...Steve and Ken...<br /><br />I think this sign is more consistent with crochetage though I would be reluctant to call it that unless it had a very classic appearance in ALL the inferior leads; a RBBB would make it even better. I do not think it has anything to do with electrode placement over an artery because the notch is located in the QRS and cardiac mechanical systole doesn't take place until the latter part of the ST segment and the T wave. A peripeheral pulse probably occurs even later than that. The calcium-induced calcium release which leads up to myofibril contraction doesn't occur until midway through Phase 2 (ST segment).<br /><br />If she was not aware of any history of secundum ASO defect then she should have a cardiological evaluation. Sometimes the patients ARE aware of these problems but you just have to drag it out of them. One of these days I'll tell you about my encounter with a young patient with a PDA during my very first night ever in the emergency department as an internal medicine resident.Jerry W. Jones, MD FACEPhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77728306446227999612020-01-10T07:24:25.669-06:002020-01-10T07:24:25.669-06:00It is unlikely we'll get followup, but I have ...It is unlikely we'll get followup, but I have asked for it!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-24396650542818788392020-01-08T09:53:18.955-06:002020-01-08T09:53:18.955-06:00Sad that follow up isn't possible, but that...Sad that follow up isn't possible, but that's part of it all I guess!Cully Whttps://www.blogger.com/profile/05651306737752782211noreply@blogger.com