tag:blogger.com,1999:blog-549949223388475481.post1870013725769650845..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A man in his 30s with chest painUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-549949223388475481.post-85639336927036398902020-04-02T12:46:20.620-05:002020-04-02T12:46:20.620-05:00I agree completely Jerry — :)I agree completely Jerry — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15192682398479597072020-04-01T21:25:36.190-05:002020-04-01T21:25:36.190-05:00Thanks Ken. Overall, my take on possible "sig...Thanks Ken. Overall, my take on possible "significant" Q waves in the anterior leads of the second ECG is this: in this context, "significant" implies pathological because there are never septal q's in the precordial leads until we get to V5 and V6. If there ARE q waves present - and I really am not convinced there are any - they would be microscopic and definitely not "significant" or pathological.Jerry W. Jones, MD FACEP FAAEMhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12423365357342755212020-04-01T20:37:59.891-05:002020-04-01T20:37:59.891-05:00THANKS as always for your excellent input Jerry! I...THANKS as always for your excellent input Jerry! I believe we say the same thing, but in different words for the appearance of the ST-T wave in the inferior leads. I didn’t comment on the 2nd ECG that was done. Looking at it now — I’d favor there being a Q wave in lead V1 (although this isn’t abnormal as an isolated finding — and I’m not sure that loss of the ever-so-tiny initial r that we saw in the 1st ECG in V1 is a “real” finding). Lead V2 in the 2nd ECG to me has a definite small initial r wave (though again, as per my comment above — leads V1 and V2 are almost certainly malpositioned on these tracings — so WHO KNOWS what the “real V1” looks like?). Leads V3 and V4 to me are initeresting in the 2nd ECG — in that it almost looks like there is a tiny initial negative deflection before a small 1 mm r wave — and then the deep S wave. And there might be a tiny initial q in lead V5. That said — I wouldn’t be convinced these findings were significant (or even real) from this tracing — and as we all agree, it is those ST-T wave abnormalities in multiple leads that are definitive for acute OMI in progress. And I fully realize that others might have a different opinion on the above than mine. THANKS again so much for your comments Jerry! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57698810379960587912020-04-01T15:18:00.114-05:002020-04-01T15:18:00.114-05:00Thanks!Thanks!Alessandro Vellahttps://www.blogger.com/profile/12688619839724440348noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-66191655432833553222020-04-01T10:05:10.291-05:002020-04-01T10:05:10.291-05:00Thanks to everyone and Tom, it's good to see y...Thanks to everyone and Tom, it's good to see your input!<br /><br />The first things that I noticed were the merging of the upward sloping of the ST segments in the inferior leads into an upright T wave that appears to be in the process of widening. I always pay close attention when the upward slope of the ST segment begins at the J-point with virtually no expression on the baseline and ends at the peak of the T wave. Often (but not always) this represents a hyperacute T wave "in the making." It's been mentioned in the literature for many years and during my classes I refer to it as "Jones's Sign." It's easily missed but should always be considered in the context of the patient's presentation. Of course, the inverted T wave in aVL also immediately caught my eye.<br /><br />Moving on the the precordial leads, I also quickly saw the inverted P waves in V2 and V3. I would guess that the medics had left the patient hooked up to the electrodes as initially placed to save time repeating the ECG. I have no idea what effect this may have on repolarization changes - perhaps someone could do a study sometime.<br /><br />Ken, I agree with you that the most telling finding on the first ECG is the hyperacute T wave in V4 - and I would also extend this to V5 as well. Those hyperacute T's are classic!<br /><br />I do have a question: it was mentioned that there were significant Q waves in the anterior leads of the second ECG and, quite frankly, I don't see any at all - certainly none that are 0.04 msec wide. Any thoughts?Jerry W. Jones, MD FACEP FAAEMhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6742668589645571792020-04-01T07:37:16.878-05:002020-04-01T07:37:16.878-05:00Our pleasure Tom! — :)Our pleasure Tom! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51906423295233537882020-04-01T06:39:50.267-05:002020-04-01T06:39:50.267-05:00thank you Pendell, Ken, and Steve
tomthank you Pendell, Ken, and Steve<br /><br />tomtfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.com