tag:blogger.com,1999:blog-549949223388475481.post1194204771250238833..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Do you understand these T-wave inversions?Unknownnoreply@blogger.comBlogger9125tag:blogger.com,1999:blog-549949223388475481.post-12978504698297992942019-10-15T07:11:45.447-05:002019-10-15T07:11:45.447-05:00I am posting the following comment from Dr. Stephe...I am posting the following comment from Dr. Stephen Smith: Jerry — I have long been aware of this work by Bayes de Luna. In my opinion — it is not helpful electrocardiographically. There is an important difference between: i) ECGs that have ST depression in V2 and V3 (and, if one were to place posterior leads, probably also in V7-V9); vs ii) ECGs that have ST elevation in V5, V6, or I, aVL. Although Bayes de Luna has shown that the actual myocardial wall is "lateral" by his methods, it has no relevance to analyzing an ECG. I oppose this framework, as it makes it more difficult to treat OMIs that only have ST depression — SteveECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63035178437085210452019-10-14T11:38:17.382-05:002019-10-14T11:38:17.382-05:00Thanks so much Jerry! The link that you left works...Thanks so much Jerry! The link that you left works (just paste and click!). NICE video — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79703800362584121522019-10-14T09:36:21.999-05:002019-10-14T09:36:21.999-05:00In my post I mention that what we used to call a &...In my post I mention that what we used to call a "posterior" MI is actually a LATERAL WALL MI. I created a short video demonstrating why this is so and posted it on YouTube (https://www.youtube.com/watch?v=46_G0SFgSTc). It's also on my profile page on LinkedIn and it is also a recent post on LinkedIn.<br /><br />If you have a moment, take a look at it. Although it is animated, nothing will move for about the first minute or so while I discuss a few preliminary concepts. I hope you enjoy it!Jerry W. Jones, MD FACEPhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1781759424862213182019-10-14T05:55:40.558-05:002019-10-14T05:55:40.558-05:00THANK YOU Tom! In this particular case — there is ...THANK YOU Tom! In this particular case — there is mention of a cardiology Fellow, who apparently initially saw the case — and was in contact with his/her Attending … — so I can’t tell from the information given what the experience of the cardiology Fellow consultant was … We also don’t know from the history given whether the Attending Cardiologist initially got the whole story (including the ECG from the Urgent Care Center) — or just received brief verbal report. BOTTOM LINE: We are ALL learning every day — and my hope is that BOTH that cardiology Fellow AND the Attending Cardiologist LEARN from this case. I will never forget early on in my Attending career receiving a call from the Resident on call, in which I didn’t insist on seeing the actual ECG — and as a result, the correct diagnosis was delayed. I quickly learned the importance of insisting “Show Me the ECG you are talking about”. These days with cell phones — it takes seconds to copy a tracing … THANKS (as always!) for you comments — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79059965276703714422019-10-14T02:17:45.076-05:002019-10-14T02:17:45.076-05:00extraordinary.
it is always a pleasure watching gr...extraordinary.<br />it is always a pleasure watching great minds, as illustrated by the four of you , alex, pendell, ken , and dr jones, dissect analyze, and explain the intricacies of an interesting case, and set of ecg's. <br />i am often discouraged by the fact that our cardiology colleagues are often , even at major sites, so hesitant to act upon very concerning, non-"in-your-face-STEMI" ecgs. in 2019 (not 1919).<br />maybe next year.<br /><br />thank you guys.<br />tomtfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81956399813942050842019-10-12T14:23:15.612-05:002019-10-12T14:23:15.612-05:00THANKS Jerry! Excellent points that you bring up —...THANKS Jerry! Excellent points that you bring up — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12863309661602278022019-10-12T12:58:12.868-05:002019-10-12T12:58:12.868-05:00A very interesting and important ECG. My thanks to...A very interesting and important ECG. My thanks to Drs. Bracey, Meyers and Grauer. My first impression from the initial ECG presented (done in the ER) was that you were dealing with reperfusion T waves and a Wellens-type syndrome. I was suspicious that this was a momentary occlusion of a distal type 3 ("wraparound") LAD because of the involvement of V3 (which also follows the conventional thought that Wellens syndrome is an LAD phenomenon). V3 is a bit far for the LCX or RCA to reach (but obviously not impossible for the RCA, since it is capable of affecting V1 - V6). The ECG done at the urgent care facility, however, was clearly an acute inferior epicardial ischemia with lateral wall extension. STD in V1 - V3 represents a lateral wall epicardial ischemia. The "true" posterior wall of the heart faces the right shoulder and will typically manifest infarctions as conduction delays or notching in V3 and V4 (probably mostly V4). Since V2 - V6 appear to have been involved at different points, this appears to be an occlusion of a superdominant RCA distal to the RV branches (sometimes referred to as a "mega-artery").Jerry W. Jones, MD FACEPhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78439854491414956492019-10-12T10:47:51.033-05:002019-10-12T10:47:51.033-05:00THANKS so much for the kind words. I believe it is...THANKS so much for the kind words. I believe it is a highly insightful case! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55564846880661341422019-10-11T16:11:16.254-05:002019-10-11T16:11:16.254-05:00Mind blowing analysis by Dr. Ken. Thank you Mind blowing analysis by Dr. Ken. Thank you Rayoflighthttps://www.blogger.com/profile/05553086415419709406noreply@blogger.com