Dr. Smith, thank you as always for the fantastic education! in this case, where the thrombus embolized from proximal to distal RCA, would it be reasonable to say that inverted reperfusion T waves in V1 and V2 may have developed to replace the STE when the proximal occlusion was essentially spontaneously cleared by virtue of the thrombus traveling distally?
Touche for Dr. Smith - excellent insight provided by this tracing to the site of occlusion in the RCA (that was not initially picked up by the interventionalist . . . ). GREAT case! - : ) Ken Grauer, MD
i can just imagine the conversation in the cath lab: "dr Heart, its doctor Smith from the ED , again" pause, and tremors. "damn!, this wasn't even his patient. tell him i'm in the john". "dr heart, he knows you're doing the cath now". "ok, ok." he takes the phone. "Steve! how are you today?" the rest is history. very nice case, Steve.
Why there is no sign of Posterior MI?? isnt some STd common in anterior leads; inferior STEMI with RV infarct is it common(without posterior MI)??? Thank you for the case...
Posterior MI occurs in inferior MI when there are posterior branches of a dominant RCA or dominant circ. RV MI occurs when RCA is occluded very proximally, before the RV marginal branch. It is only associated with posterior MI when there are downstream posterior branches, which occurs maybe 35% of the time.
DEAR READER: I have loved receiving your comments, but I am no longer able to moderate them. Since the vast majority are SPAM, I need to moderate them all. Therefore, comments will rarely be published any more. So Sorry.
Dr. Smith,
ReplyDeletethank you as always for the fantastic education!
in this case, where the thrombus embolized from proximal to distal RCA, would it be reasonable to say that inverted reperfusion T waves in V1 and V2 may have developed to replace the STE when the proximal occlusion was essentially spontaneously cleared by virtue of the thrombus traveling distally?
thanks,
David
Indeed, on the post-cath ECG the T-wave in V1 was inverted.
ReplyDeleteTouche for Dr. Smith - excellent insight provided by this tracing to the site of occlusion in the RCA (that was not initially picked up by the interventionalist . . . ). GREAT case! - : ) Ken Grauer, MD
ReplyDeleteThanks for the kind words, Ken!
ReplyDeletehi Steve...
ReplyDeletei can just imagine the conversation in the cath lab:
"dr Heart, its doctor Smith from the ED , again"
pause, and tremors.
"damn!, this wasn't even his patient. tell him i'm in the john".
"dr heart, he knows you're doing the cath now".
"ok, ok."
he takes the phone. "Steve! how are you today?"
the rest is history. very nice case, Steve.
Why there is no sign of Posterior MI?? isnt some STd common in anterior leads; inferior STEMI with RV infarct is it common(without posterior MI)???
ReplyDeleteThank you for the case...
Posterior MI occurs in inferior MI when there are posterior branches of a dominant RCA or dominant circ. RV MI occurs when RCA is occluded very proximally, before the RV marginal branch. It is only associated with posterior MI when there are downstream posterior branches, which occurs maybe 35% of the time.
Delete