tag:blogger.com,1999:blog-549949223388475481.post1026602338818976513..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Elderly with Paced Rhythm, Possible Ischemic symptoms, and an Equivocal Smith Modified Sgarbossa ECGUnknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-549949223388475481.post-55153880509439411982019-09-28T17:22:10.302-05:002019-09-28T17:22:10.302-05:00Thanks, Jerry. Sorry for the delay. Was on vacatio...Thanks, Jerry. Sorry for the delay. Was on vacation and then buried!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3335375804724519032019-08-21T12:18:03.130-05:002019-08-21T12:18:03.130-05:00Steve...
Excellent case and great comments from K...Steve...<br /><br />Excellent case and great comments from Ken.<br /><br />My take on this is that this is likely a proximal occlusion of a non-dominant LCx. The ST depressions in V1 - V3 are indicative of what we NOW know to be an infarction of the lateral wall of the LV. The obtuse marginals serve the lateral wall and the apicolateral region (V5 and V6). But there is no inferior involvement, so the RCA is dominant.<br /><br />This is an important piece of information because the apicolateral (lower lateral) wall of the LV is just about the BEST perfused area of the heart under normal circumstances. It is served by the LAD, the LCx, the RCA (when dominant) and the ramus intermedius (when present). When we see ischemia in this area due to a single occluded artery, you must surmise that the other arteries serving that area are also impaired (or else simply not present).<br /><br />Occlusions of either the LCx or a dominant RCA can cause STE in V5 and V6. It's actually more common with the LCx but not so much more that the information is useful diagnostically. STE in V5 and V6 should always make you suspicious of the integrity of the other coronary vessels.Jerry W. Jones, MD FACEPhttps://www.medicusofhouston.comnoreply@blogger.com