tag:blogger.com,1999:blog-549949223388475481.post1624803425239602914..comments2024-03-19T02:33:29.499-05:00Comments on Dr. Smith's ECG Blog: Subtle LAD Occlusion with Pseudonormalization of Wellens' Waves.Unknownnoreply@blogger.comBlogger14125tag:blogger.com,1999:blog-549949223388475481.post-80940535254925859332017-05-24T05:42:37.528-05:002017-05-24T05:42:37.528-05:00Oh, yes, that is just because the lesion was proxi...Oh, yes, that is just because the lesion was proximal to the first Diagonal. Anterolateral MI, not just anterior.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35238895152915376872017-05-22T21:03:25.515-05:002017-05-22T21:03:25.515-05:00Sorry, not STD, but only TWI... Sorry, not STD, but only TWI... MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25827706878983669912017-05-22T08:50:46.731-05:002017-05-22T08:50:46.731-05:00I don't see any STD in I and aVL. In fact, the...I don't see any STD in I and aVL. In fact, there is a tiny bit of STE.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63201368385402462312017-05-20T20:56:26.141-05:002017-05-20T20:56:26.141-05:00Hello doctor, ECG 2 in this post "Here is hi...Hello doctor, ECG 2 in this post "Here is his ED ECG from that visit, after resolution of chest pain" <br />What to make of the subtle STD n T wave inversions in lead 1 n lead aVL? Are those reciprocal changes indicative of evolving inf wall STEMI? Do we discharge the pt saying he may develope MI(wellens) or he is in the stage of an ongoing n MI(Reciprocal changes) ? MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38817675230672762792014-12-21T09:35:29.410-06:002014-12-21T09:35:29.410-06:00it is a J-wave but we also see these in anterior M...it is a J-wave but we also see these in anterior MISteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16170459684605305072014-12-20T22:31:22.580-06:002014-12-20T22:31:22.580-06:00Dear Dr Smith,
Am I wrong in saying that there i...Dear Dr Smith,<br /> Am I wrong in saying that there is J wave in lead V4 -V5 and that could be due to early repolarization.<br />regards,<br />Amita.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87837987355243920382014-12-18T14:37:20.369-06:002014-12-18T14:37:20.369-06:00I'm sure you cannot find it anywhere. In fact...I'm sure you cannot find it anywhere. In fact, there is no literature that shows that Wellens' waves are reperfusion waves. This is, as far as I can tell, an idea that I have propagated based on reperfusion literature from Wehrens http://www.sciencedirect.com/science/article/pii/S0002870300900863 and Doevendans http://www.sciencedirect.com/science/article/pii/S0002914999807632Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85355161896209307982014-12-18T08:56:47.860-06:002014-12-18T08:56:47.860-06:00Where can I find a good explanation as to why we s...Where can I find a good explanation as to why we see the findings of wellens after reperfusion and pseudonormalization after reperfusion from an electrical phys point of view?Lillyhttps://www.blogger.com/profile/03039927976082775986noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-42435259801758882052014-12-18T06:44:22.005-06:002014-12-18T06:44:22.005-06:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23788964941463585502014-12-18T06:43:44.630-06:002014-12-18T06:43:44.630-06:00Peter: Yes. This is why one cannot rely on any on...Peter: Yes. This is why one cannot rely on any one determinant. the most important of all is R-wave amplitude. Here there are Q-waves, making early repol impossible!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14019739504197293672014-12-18T06:42:42.024-06:002014-12-18T06:42:42.024-06:00Yes. Good observation.Yes. Good observation.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-20066121942505350302014-12-17T16:15:03.793-06:002014-12-17T16:15:03.793-06:00Thanks,dr.Smith
Is ST segment elevation significan...Thanks,dr.Smith<br />Is ST segment elevation significant by its millimeters of elevation or I should consider it significant if there is ST segment depression as in the first EKG..STe of one millimeter in leads I and aVL and STd in leads II,III and aVF<br />~KhaleDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35722259041884953802014-12-17T14:58:00.709-06:002014-12-17T14:58:00.709-06:00Steve,
Nice case! A little unusual that the QTc is...Steve,<br />Nice case! A little unusual that the QTc is so short, wouldn't you say?<br />/PeterP Hammarlundhttps://www.blogger.com/profile/12795866723817205360noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22784720725640949522014-12-17T14:34:51.526-06:002014-12-17T14:34:51.526-06:00GREAT case (though clearly unfortunate for the pat...GREAT case (though clearly unfortunate for the patient). Additional clues on the initial ECG that the QS complexes in V1,V2,V3 and the J-point ST elevation in lead V3,V4 are NOT normal - are: i) there is a Q wave as well as definite ST elevation in the low-amplitude complex in lead aVL; and ii) there is ST segment flattening and even some depression in the inferior leads - which together with the findings in lead aVL goes along with a proximal LAD occlusion.<br /><br />THANKS for posting!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com