tag:blogger.com,1999:blog-549949223388475481.post2082236194718586768..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)Unknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-27646371991795501092015-05-27T06:43:25.082-05:002015-05-27T06:43:25.082-05:00See if this explains it for you: http://hqmeded-ec...See if this explains it for you: http://hqmeded-ecg.blogspot.com/search?q=formulaSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-31205763353520692912015-05-27T01:22:49.946-05:002015-05-27T01:22:49.946-05:00canyou explain the st segment deviation score plz...canyou explain the st segment deviation score plz ??Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-89802014294422813652011-06-20T20:39:43.105-05:002011-06-20T20:39:43.105-05:00It all depends on the cutoff. And you have to reme...It all depends on the cutoff. And you have to remember this is in my study of patients whom cardiologists call "ER" and who have at least 1 mm STE in one lead. Versus patients with LAD occlusion that is not obvious. For this group, 384ms was 95% sensitive for MI, but only 44% specific. >438 was 95% specific for MI, but only 29% sensitive. The AUC of the ROC curve for QTc was 0.82. Pretty good, but not great. The AUC for R-wave amplitude was 0.87.<br /><br />As for troponin, the 99% is the cutoff for MI or not, with appropriate rise and fall. So the 99% reference range cannot be 14pg/ml but 30-60 be "equivocal" and > 60 probable.<br /><br />It unfortunate, but interpretation of troponin levels is incredibly complex and impossible to cover in a blog posting.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-26255892659114886012011-06-20T13:21:32.195-05:002011-06-20T13:21:32.195-05:00I know this is a shot in the dark but do you have ...I know this is a shot in the dark but do you have sensitivity, specificity of QTc for ER too?<br /><br />The 99% percentile is at 14 pg/mL of Troponin T, there was also a lab qualifying statement of WHO criteria:<br />30-60 pg/mL - equivocal for MI<br />>60 probableIatrophobichttps://www.blogger.com/profile/16961047788670399788noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-45020357029243244252011-06-19T15:33:09.958-05:002011-06-19T15:33:09.958-05:00Remember, this is only to be applied when the ques...Remember, this is only to be applied when the question is: is this ER or anterior STEMI? Then the QTc by itself, unless very high (> 430 = 90% specific, > 440 = 95% specific) or low (< 384 ms = 95% sensitive) is not great, but combined with STE and R-wave in the equation, it works well. <br /><br />As for troponin, you'd have to tell me exactly which assay you're referring to. The product, whether troponin I or T. The critical information is its 99% reference value, its limit of detection (LoD), and its 10% coefficient of variation (CV).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72437932496233824992011-06-19T14:47:32.805-05:002011-06-19T14:47:32.805-05:00This is one of the lowest QTc by far I've seen...This is one of the lowest QTc by far I've seen with ACS. Thanks. BTW, our interventionist won't even look or consider QTc as a possible help for those unclearcut ECGs.<br /><br />On another issue, Dr Smith would you comment on the supersensitive TnT that is out in some hospitals. Ours have it at pg/mL. I don't know if I would just have to multiply the ng/mL by a factor of 100 to get the equivalent in pg/mLIatrophobichttps://www.blogger.com/profile/16961047788670399788noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27614433243115315212011-06-18T16:30:37.301-05:002011-06-18T16:30:37.301-05:001. Pain was typical for MI (substernal, not postio...1. Pain was typical for MI (substernal, not postional or sharp, resolved with NTG)<br />2. Pericarditis ST elevation is maximal in leads II and V5, V6. Here the ST elevation is maximal in V2-V4. <br />3. Pericarditis does not have hyperactue T-waves.<br />4. Tight proximal LAD stenosis explains STE in precordial leads and I and aVL.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32704151730276309162011-06-18T15:21:35.764-05:002011-06-18T15:21:35.764-05:00Hello everyone.
In the first EKG we notice widesp...Hello everyone.<br /><br />In the first EKG we notice widespread ST elevation without mirror and PR depression, in aVr there's ST depression with PR elevation : why don't we consider the diagnosis of pericarditis ?hfkarimhttps://www.blogger.com/profile/00135037037153638679noreply@blogger.com