tag:blogger.com,1999:blog-549949223388475481.comments2024-03-19T02:33:29.499-05:00Dr. Smith's ECG BlogUnknownnoreply@blogger.comBlogger8498125tag:blogger.com,1999:blog-549949223388475481.post-7117336698503877032023-12-22T15:56:58.673-06:002023-12-22T15:56:58.673-06:00I think you are both using the retrospectoscope, a...I think you are both using the retrospectoscope, and if I had put this in a mix of a hundred ECGs of unknown outcome, you would not have recognized it as OMI. The Queen says OMI because she sees what she thinks are posterior reperfusion T-waves. She calls OMI whenever she sees EITHER and active or a reperfused OMI. But this is during active chest pain and has no evidence whatsoever of active circumflex occlusion. <br /><br />This is a repost of a case I put up years ago. I have searched in vain for that blog post without success. I had the EKG in one of my powerpoints, but lost the file on my computer, where the other EKGs were also. There was no old EKG and subsequent EKGs were unrevealing. <br /><br />Any OMI you are seeing here is your imagination. Because it wasn't there.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73286300198443873452023-12-22T15:30:23.276-06:002023-12-22T15:30:23.276-06:00Great case Steve!
I agree with all the principle...Great case Steve! <br /><br />I agree with all the principles you have emphasized here. Although I must say I agree with Ken! Yes there's bradycardia but the T-waves still catch my eye not only because of their size and morphology but also due to the ST-Takeoff and morphology of the ST segments. I have several questions: Was there a prior ECG for comparison? Were there any repeat ECGs? Do you have any post-cath ECGs? All these would help delineate the electrocardiographic evolution. Also was this a Left-Dominant Coronary Circulation(PDA off the Circ?). Do you have any cath images? Finally, although this wasn't an LAD Occlusion should not cut off the R wave in V4 which appears to be cropped on the original but then not on the digitized version!<br />Sam@EM_RESUShttps://www.blogger.com/profile/07335337127966226168noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46397718614324128232021-10-27T18:10:07.519-05:002021-10-27T18:10:07.519-05:00Hello JJ. Please take ANOTHER LOOK at this blog po...Hello JJ. Please take ANOTHER LOOK at this blog post — See My Comment (at the bottom of the page) which I added just this morning (Oct. 27). I take a DETAILED LOOK at the rhythm for the first 3 tracings, and explain my assessment with laddergrams. Please let us know if you still have questions after reviewing My Comment. THANK YOU for your interest in Dr. Smith's ECG Blog! — :) Ken Grauer, MDECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34417756037822797792021-10-27T18:09:48.025-05:002021-10-27T18:09:48.025-05:00Hello Anna. Please take ANOTHER LOOK at this blog ...Hello Anna. Please take ANOTHER LOOK at this blog post — See My Comment (at the bottom of the page) which I added just this morning (Oct. 27). I take a DETAILED LOOK at the rhythm for the first 3 tracings, and explain my assessment with laddergrams. Please let us know if you still have questions after reviewing My Comment. THANK YOU for your interest in Dr. Smith's ECG Blog! — :) Ken Grauer, MDECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-20471599780518754302021-10-25T13:15:19.064-05:002021-10-25T13:15:19.064-05:00Sorry, but I think in ECG named "30 minutes l...Sorry, but I think in ECG named "30 minutes later (time = 60 minutes)" it is not AV block 2:1, but 3:1 or even complete AV block with some type of rescue rhythm (P rate is near 150 bpm)<br /><br />And in ECG named <br />"30 minutes later, another ECG was recorded" it is not only P waves not conducted more than 3 times (may be it is 2:1-3:1 conduction?) <br /><br />Or am I seeing something wrong?<br /><br />Thank you for this great case, and all you work, and this exellent blog - I've been reading it for many years, it helps a lot in my work. Best regards, dr Anna Cherniakova from Russia :)Annahttps://www.blogger.com/profile/09551567104196318354noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75597280079481701702021-10-25T10:29:10.811-05:002021-10-25T10:29:10.811-05:00I think the ECG[30 minutes later (time = 60 minute...I think the ECG[30 minutes later (time = 60 minutes)] is 3:1 AV block with a P wave buried in R wave?JJhttps://www.blogger.com/profile/17519255052010474217noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25111444224322915222021-08-17T12:00:33.475-05:002021-08-17T12:00:33.475-05:00By the way, the first ECG displays a tiny bit of S...By the way, the first ECG displays a tiny bit of STE in V4-V5 compared to the baseline. But this can be easily missed...Alexey Rukinhttps://www.blogger.com/profile/10648952895362962043noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55490752399991417172021-08-12T22:45:02.746-05:002021-08-12T22:45:02.746-05:00very interesting indeed. thank you all.very interesting indeed. thank you all.tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49646937047005487992021-08-12T22:25:07.480-05:002021-08-12T22:25:07.480-05:00love this post. i guessed RCA, incorrectly.love this post. i guessed RCA, incorrectly.tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61985417056279906672021-08-10T15:01:31.349-05:002021-08-10T15:01:31.349-05:00Well now I know that case I encountered months ago...Well now I know that case I encountered months ago was this exactly. Thank you. Great case! Hussain Chhttps://www.blogger.com/profile/16052395070341334275noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75707337338476463942021-08-10T15:01:00.444-05:002021-08-10T15:01:00.444-05:00Well now I know that case I encountered months ago...Well now I know that case I encountered months ago was this exactly. Thank you. Great case! Hussain Chhttps://www.blogger.com/profile/16052395070341334275noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18949625029017234902021-08-10T12:59:37.135-05:002021-08-10T12:59:37.135-05:00great explanation
great explanation<br />Graydocerhttps://www.blogger.com/profile/18001264547915951825noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90468324730131093562021-08-10T10:41:04.955-05:002021-08-10T10:41:04.955-05:00Great case Steve.. when I first looked at the ECG ...Great case Steve.. when I first looked at the ECG I saw Infero-Posterior OMI. Was this a Dominant Left-Circumflex Occlusion? Even retrospectively I just really don't see much STE in aVR. I see STE in II, III, aVF, worrisome ST-Takeoff, and relatively large T waves. Furthermore I think there is more STD in V4 than V5. Lead placement could easily account for lack of STD in V2, and for the less than classic (for Posterior MI) depression vector in the precordial leads. Overall I see a very subtle Infero-Posterior OMI and not "Aslanger's Pattern". Interested as always to hear your thoughts on my take. Thanks for sharing the case!@EM_RESUShttps://www.blogger.com/profile/07335337127966226168noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72772159681312371162021-08-08T13:52:04.986-05:002021-08-08T13:52:04.986-05:00It certainly at least resembles one. good eye!It certainly at least resembles one. good eye!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-45781109024165414282021-08-08T13:51:08.234-05:002021-08-08T13:51:08.234-05:00Yes, so this is unusual, but not unheard of.Yes, so this is unusual, but not unheard of.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76087382781403471192021-08-08T13:50:12.043-05:002021-08-08T13:50:12.043-05:00Not for me or you, but for many othersNot for me or you, but for many othersSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18497158951138731572021-08-08T13:47:58.135-05:002021-08-08T13:47:58.135-05:00don't usually call Aslanger pattern if it is t...don't usually call Aslanger pattern if it is type 2 MI, but why not?Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49146816617467313162021-08-08T13:46:27.652-05:002021-08-08T13:46:27.652-05:00well, you are right. there is some STD in inferior...well, you are right. there is some STD in inferior leads as well. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-4722990014068794092021-08-07T09:26:06.494-05:002021-08-07T09:26:06.494-05:00Is that Alslanger pattern doc smith there is st el...Is that Alslanger pattern doc smith there is st elevation Anonymoushttps://www.blogger.com/profile/15626451005015514818noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7077846856182673672021-08-06T09:11:34.033-05:002021-08-06T09:11:34.033-05:00Dr.Smith
Reg Dr Smith's ECG BLOG: Tuesday- Au...Dr.Smith <br />Reg Dr Smith's ECG BLOG: Tuesday- Aug 3rd 2021.<br /><br />Congratulations for posting this superb case.<br /><br />A major infarction lurking behind a totally inconspicuous ( barely 1mm) STD is spotted and patient<br />is pulled out of the jaws of death by timely intervention - all with evidence based push.<br /><br />This magical cure is simply phenomenal.<br /><br />Dr.Smith has been teaching us all along with real world ECGs centering on SUBTLE ECG Manifestations<br />of ACS through his Book and Blog; but "THIS ONE TAKES THE CAKE". Hats off to you Dr Smith.<br /><br />With regards,<br />Dr.R.Balasubramanian<br />Pondicherry- INDIAdr. R.Balaubramanianhttps://www.blogger.com/profile/10882266041266448279noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78994868465838327912021-08-06T08:52:34.370-05:002021-08-06T08:52:34.370-05:00have to confess that I am still not able to confid...have to confess that I am still not able to confidently see the STD over the precordial leads even after reading your explanation. But what about the inferior leads? I think they also had some STD which looks more obvious to me. Did they affect your interpretation in this case?Anonymoushttps://www.blogger.com/profile/05315671855718045013noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55071560705907456102021-08-06T01:56:48.736-05:002021-08-06T01:56:48.736-05:00thank you Brooks. i don't even ever look a the...thank you Brooks. i don't even ever look a the computer interpretation like ever (Steve has told me that's not a great thing to do, to not look at all), well, sometimes , like if i have a question in my mind regarding blocks or rhythm, i'd look.<br />this is a clear OMI , i think, and i think there's a mm ST seg elevation in lead III if you use the T-P segment as Mattu suggests.<br /><br />thank you, Brooks<br /><br />tom tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-4535130785378302802021-08-06T01:26:04.774-05:002021-08-06T01:26:04.774-05:00extraordinary... and not a little scary and discon...extraordinary... and not a little scary and disconcerting. thanks Steve.<br /><br />tomtfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75564655683344215852021-08-06T01:08:35.419-05:002021-08-06T01:08:35.419-05:00incredible Steve.... i an sorry to say that i rece...incredible Steve.... i an sorry to say that i recently saw a case where there were significant in-your-face ST depressions in V2-3, with chest pain. (sent to me by my brother at another institution). the ED doc just thought it was ischemia , ACS and was admitted to the medical floor. we are just coming out of the Dark Ages, in so many ways.<br /><br />thank you for this.<br />tom tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75543876300910002402021-08-04T07:06:26.607-05:002021-08-04T07:06:26.607-05:00Hi,
Given the hyperacute T waves in case 12, is th...Hi,<br />Given the hyperacute T waves in case 12, is the formula necessary?Anonymoushttps://www.blogger.com/profile/07764762669164998540noreply@blogger.com