tag:blogger.com,1999:blog-549949223388475481.post2288886596352354313..comments2024-03-19T02:33:29.499-05:00Comments on Dr. Smith's ECG Blog: A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST ElevationUnknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-832973975148654942019-09-29T08:43:47.194-05:002019-09-29T08:43:47.194-05:00K.
We studied concavity and convexity in our large...K.<br />We studied concavity and convexity in our large studies of LBBB with occlusion. 50% of them had upward concavity in all leads.<br />A single lead with convexity was very specific, but it was not at all sensitive.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39498194847001338582019-09-28T21:29:08.814-05:002019-09-28T21:29:08.814-05:00@ KRiS — THANK YOU for your comment! I DID see tha...@ KRiS — THANK YOU for your comment! I DID see that subtle ST elevation in lead aVL of ECG #1 at the time I wrote My Comment — but I chose NOT to include this in my impression, because given the marked ST-T wave deviations in other leads (and the markedly increased QRS amplitudes in selected leads) — I was NOT at all certain that this finding in lead aVL was "real" (ie, indicative of an acute process). We just don't see suggestion of ST elevation in other lateral leads. I've informally studied this over the years — and I'm fully aware that on occasion, lead aVL ( = the "most lateral" of the high lateral leads) may be the ONLY lead to show ST elevation — but my hunch was that this just didn't look to be acute in ECG #1 ( = my hunch). And, given how DIFFERENT the QRS complex in lead aVL of ECG #1 looks compared to the QRS in aVL after NTG — I do not think ( = my opinion) that we can say that NTG "improved" the ST segment appearance ... I hope that makes sense — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81770699506001412032019-09-28T21:06:28.201-05:002019-09-28T21:06:28.201-05:00THANKS for your comment K. I agree that shape of t...THANKS for your comment K. I agree that shape of the ST segments in this case further supports that this is unlikely to represent an acute cardiac event. Throughout my teachings — I've always emphasized that "SHAPE is more important than amount" (when talking about ST segment deviation. That said — I need to inject a word of caution that a "concave up" ( = "smiley"-configuration) shape is not always "benign" ... — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-21196286038176691872019-09-27T09:47:48.741-05:002019-09-27T09:47:48.741-05:00In this case, the ST segments are all concave, ind...In this case, the ST segments are all concave, indicating they are benign. In STEMI, the ST segments are convex. Yes, I definitely pay attention to whether the elevated ST segment is concave or convex regardless of the height of the ST elevation.<br />K. Wang. <br />Anonymoushttps://www.blogger.com/profile/04509940285330859355noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81949610239137932552019-09-26T09:49:45.625-05:002019-09-26T09:49:45.625-05:00I think the 1st ECG at aVL it looks like there’s s...I think the 1st ECG at aVL it looks like there’s subtle ST elevation and did improve after nitrateKRiShttps://www.blogger.com/profile/00034557278527221660noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14576610093817043932019-09-25T17:33:12.677-05:002019-09-25T17:33:12.677-05:00We Often see Type 2 in very sick elderly patients ...We Often see Type 2 in very sick elderly patients eg. sepsis, Multi organ failure rmhttps://www.blogger.com/profile/09645240328579509925noreply@blogger.com