tag:blogger.com,1999:blog-549949223388475481.post1321024818217258828..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Biphasic T-waves in a Middle-Aged Male with VomitingUnknownnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-549949223388475481.post-2364356044803349522020-05-31T12:25:03.587-05:002020-05-31T12:25:03.587-05:00Sometimes it is extremely difficult to distinguish...Sometimes it is extremely difficult to distinguish between biphasic T waves and U waves. That said — Dr. Smith offers some suggestions in his Learning Points. So — a very long QT (really a QU) would be more likely with hypokalemia (in which case we are dealing with large U waves). Also — look at ALL 12 leads, because sometimes you will see clear U waves in some of the leads (but not in others). So clinical setting is key (Are you dealing with recent MI that now shows reperfusion — vs a clinical setting that predisposes to electrolyte disorders). Finally, the deflection in question will often “look like” either a biphasic T wave or a U wave. This is hard to explain (“A picture tells 1,000 words”) — but if we are dealing with a large U wave that subtly fuses into the terminal portion of the T wave — then that wave will be LONGER than if it simply represented the 2nd half of a biphasic T wave. So regarding this case and the 1st ECG — the clinical setting is “right” (ie, vomiting) — the QT (QU) is VERY long — and leads V5, V6 manifest a terminal positive deflection that just continues for far too long to simply be the 2nd half of a biphasic T wave — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-86830654584270877282020-05-31T08:31:13.828-05:002020-05-31T08:31:13.828-05:00How to differentiate between the biphasic T wave a...How to differentiate between the biphasic T wave and U waves ?Fenerhttps://www.blogger.com/profile/15589031274930737000noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46874553984659942792017-11-16T14:22:18.123-06:002017-11-16T14:22:18.123-06:00as aboveas aboveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77201821187197612522017-11-16T14:21:57.232-06:002017-11-16T14:21:57.232-06:00Sometimes in RBBB, in V1-V3 there is a negative T-...Sometimes in RBBB, in V1-V3 there is a negative T-wave that may end in a very small positive deflection, but I would not call it a down up t wave. And of course there is no RBBB here.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85280855959156524882017-11-16T10:17:10.669-06:002017-11-16T10:17:10.669-06:00Could down-up T waves be explained by an abnormal ...Could down-up T waves be explained by an abnormal depolarisation (ie. RBBB)? Or should they always prompt further investigation. Ignaciohttps://www.blogger.com/profile/17167805476232042017noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-69926636386458450582017-11-16T10:15:58.784-06:002017-11-16T10:15:58.784-06:00Are down-up T-waves a finding that could be explai...Are down-up T-waves a finding that could be explain in precordial leads by the presence of RBBB? Ignaciohttps://www.blogger.com/profile/17167805476232042017noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61084548285490794612016-11-13T15:59:51.546-06:002016-11-13T15:59:51.546-06:00Certainly, following epicard injury or even a sube...Certainly, following epicard injury or even a subendocardial injury the repeperfusion is characterized by a resolution of the pain and the T waves are starting to inverte, intialy from their terminal end then middle and proximal end .Anonymoushttps://www.blogger.com/profile/14581534041446830166noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19783752115354601402016-11-12T08:14:51.765-06:002016-11-12T08:14:51.765-06:00Wellens' waves are reperfusion T-waves. When ...Wellens' waves are reperfusion T-waves. When STEMI is reperfused, one of the first signs of reperfusion is the downward turn of the end of the T-wave. In Wellen's syndrome, there is absence of recording during chest pain, when one would have found STEMI. The artery reperfuses, the pain goes away, and the first recording you get is the terminal T-wave inversion. If you wait longer, you'll get pattern B (deep symmetric T inversion), as over time Pattern A evolves into Pattern B.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8957292355576083092016-11-12T04:33:23.469-06:002016-11-12T04:33:23.469-06:00Dr. Smith, from the electrocariographic point of v...Dr. Smith, from the electrocariographic point of view can we say that Wellens' waves are the evolution of an early ST elevation? Thanks in advance.Mario Parrinellohttps://www.blogger.com/profile/07136945770330333718noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16608039241713939922016-11-11T15:16:15.190-06:002016-11-11T15:16:15.190-06:00Intracrani hemorrhage can produce variety of ECG c...Intracrani hemorrhage can produce variety of ECG changes from the bradycardia and increase QT intervals, ST -T changes, abnormal rhythm, and abnormal conduction such as the BBB or alternating BBB block. Anonymoushttps://www.blogger.com/profile/14581534041446830166noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47162278054512191732016-11-11T07:26:14.905-06:002016-11-11T07:26:14.905-06:00IC hemorrhage can cause a wide variety of ECG find...IC hemorrhage can cause a wide variety of ECG findings and I wouldn't be surprised if it led to the ones you describe.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-67318222616189645292016-11-10T07:33:40.068-06:002016-11-10T07:33:40.068-06:00Thank you for sharing this case,really helpful.
Dr...Thank you for sharing this case,really helpful.<br />Dr-Steve I have a question away from this topic,will be appreciated to get answer .<br />Can intracranial hemorrhage or CVA Presented by alternating BBB?<br />As a young male came with sudden loss of vision then deteriorating level of consciousness,ECG alternating RT,LT BBB,then deteriorating to VT then death.<br />RegardsOlla ibrahimhttps://www.blogger.com/profile/15431021498274603657noreply@blogger.com