tag:blogger.com,1999:blog-549949223388475481.post1144068627992581032..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Even with STE in V5 & V6, inferior STE without reciprocal STD in aVL is unlikely to be STEMI Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-31013616355083610712019-11-07T11:39:25.806-06:002019-11-07T11:39:25.806-06:00thanksthanksnicolo` crosa di vergagnihttps://www.blogger.com/profile/15649071735081421113noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22752842558652328492016-05-30T07:17:12.518-05:002016-05-30T07:17:12.518-05:00Emre,
LAD or D1 lesions rarely cause STE in aVL an...Emre,<br />LAD or D1 lesions rarely cause STE in aVL and inferior leads. They frequently cause STE in aVL with ST depression in inferior leads.<br />There are some exceptions<br />STeveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18920889462899530282016-05-30T07:12:50.453-05:002016-05-30T07:12:50.453-05:00This comment has been removed by the author.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-28512834650276858642016-05-26T01:19:32.503-05:002016-05-26T01:19:32.503-05:00Hi,
Was your study (on reciprocal ST depression i...Hi,<br /><br />Was your study (on reciprocal ST depression in aVL) limited to RCA and LCX lesions ? I am asking because LAD lesions including D1 but not S1 produce widespread ST elevation with ST elevation in aVL and inferior STE (in addition to anterior STE). These pose the the real problem differentiating STEMI vs. pericarditis (and vs. Early repol). Any data or comments on this?<br /><br />Thanks in advance <br />Emre Aslangerhttps://www.blogger.com/profile/15517696935176033792noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6668781289344014492016-01-13T08:27:06.518-06:002016-01-13T08:27:06.518-06:00thanks Steve!thanks Steve!Dominic Larose MD CMFC(MU) FACEPhttps://www.blogger.com/profile/12841805037815499459noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19905563156024205732016-01-11T09:36:40.132-06:002016-01-11T09:36:40.132-06:00Here is the original study: http://circ.ahajournal...Here is the original study: http://circ.ahajournals.org/content/65/5/1004.full.pdf<br />It could not be validated: https://www.researchgate.net/profile/Ravindra_Bhardwaj/publication/229426436_Differential_Diagnosis_of_Acute_Pericarditis_From_Normal_Variant_Early_Repolarization_and_Left_Ventricular_Hypertrophy_With_Early_Repolarization_An_Electrocardiographic_Study/links/546b92e90cf2397f7831c449.pdf<br /><br />There was lots of overlap. <br /><br />You'll see that their examples of pericarditis do NOT have J-waves. The examples of early repol do have J-waves. <br /><br />In the validation, the ST/S ratio in lead I > 0.25 turned out to be the best in this validation. But even that was only 65% specific for pericarditis. Not very good.<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8995685446073985502016-01-10T12:00:33.550-06:002016-01-10T12:00:33.550-06:00Has the 25% rule been proven wrong with published ...Has the 25% rule been proven wrong with published data, or is it your personal observations.Cheers!Dominic Larose MD CMFC(MU) FACEPhttps://www.blogger.com/profile/12841805037815499459noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3801857377422992182016-01-06T06:16:30.612-06:002016-01-06T06:16:30.612-06:00ECG: 1) deeper PR depression 2) absence of J-waves...ECG: 1) deeper PR depression 2) absence of J-waves 3) Spodick's sign (notice the case of pericarditis above has Spodick's sign (descending TP segment). I am not terribly confident in Spodick's sign especially since Amal Mattu has told me he conducted a good study of this and it was negative (so far unpublished, even as abstract)<br />I don't think the ECG is the best way. Other clinical info is important: 1) absence of chest wall tenderness 2) friction rub 3) pericardial effusion <br />Finally, if you don't have the above, who cares? The important diagnosis is STEMI or not and, if pericarditis, is there an effusion? Otherwise, pericarditis and chest wall pain are simply painful but benign conditions. If you have a high suspicion of pericarditis, maybe you want to add colchicine.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12870865748648020712016-01-05T23:17:03.346-06:002016-01-05T23:17:03.346-06:00OK . What method do you use to DD early repo from ...OK . What method do you use to DD early repo from pricarditis (mild) for sure? Thanks dr smithAnonymoushttps://www.blogger.com/profile/07023010684946472911noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2583818764707439822016-01-05T18:36:04.819-06:002016-01-05T18:36:04.819-06:00The 25% rule is not reliable. See the last two EC...The 25% rule is not reliable. See the last two ECGs--these are also early repol. PR depression up to 0.8 mm is also normal (normal atrial repolarization wave). Case 1 is a typical ECG of an asymptomatic patient with ST elevation (i.e., early repol); it is classic for early repol. I think many patients with chest wall pain and early repol are wrongly given the diagnosis of pericarditis.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77631993646047519222016-01-05T13:06:48.602-06:002016-01-05T13:06:48.602-06:00Case 1 st/t ratio in V6 is more then 25% also some...Case 1 st/t ratio in V6 is more then 25% also some pr depression. Did viral pricarditis r/o?Anonymousnoreply@blogger.com