tag:blogger.com,1999:blog-549949223388475481.post2896509220220025260..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Five Primary Patterns of Ischemic ST depression, without ST elevation. Some are STEMI-equivalents.Unknownnoreply@blogger.comBlogger38125tag:blogger.com,1999:blog-549949223388475481.post-90997135404425569042018-09-23T07:02:31.287-05:002018-09-23T07:02:31.287-05:00ST depression out of proportion. ST depression in ...ST depression out of proportion. ST depression in LVH should always be opposite to the QRS. In V3, R and S waves are equal, so there should be no ST deviation, but there is depressionSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80332256867543040492018-09-21T01:42:39.469-05:002018-09-21T01:42:39.469-05:00Pttern 4. Subendocardial ischemia, non-localized, ...Pttern 4. Subendocardial ischemia, non-localized, usually not as severe as #1 above:ST Depression in V3,V4-V6. ST axis is rightward, with little posterior or inferior components. <br /><br />This pattern I usually get to see in patients. Although LVH criteria is not met in most of such cases, how can we differentiate subendocardial ischaemia from LVH with strain pattern(or strain equivalent pattern) which too gives similar picture??MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-42427930742891807622018-06-11T13:46:52.968-05:002018-06-11T13:46:52.968-05:00Dear Dr Smith. Thanks to youre blog and great case...Dear Dr Smith. Thanks to youre blog and great cases I have solved a difficult case in our hospital and saved one life. I have not listened to cardiologist who told me that the case was not for PCI. Please continue to collect and share knowledge. Greetings from Serbia. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39245538545493619302018-04-06T08:58:33.226-05:002018-04-06T08:58:33.226-05:00If symptoms and ECG findings are persistent, are d...If symptoms and ECG findings are persistent, are due to ACS, and there is no possibility of intervention, only then would thrombolytics be indicated.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-52891172669135352812018-04-04T20:44:28.754-05:002018-04-04T20:44:28.754-05:00Dear Dr, thanks for your sharing!
Is it possible t...Dear Dr, thanks for your sharing!<br />Is it possible to get anginal symptoms from LM stenosis?<br />Our patient came in with a history of episodic chest pain worse with exertion<br />The ECG at the emergency department showed significant ST elevation in AVR and ST depression / T wave inversion in I, II, AVF, V3-6<br />The patient had already taken TNG and the chest pain soon subsided, with a repeat ECG in 30min showing near complete resolution of all the ST changes.<br />Should that be treated as a severe acute left main stenosis and warrant an urgent PCI? Would thrombolytics be less indicated in such cases?<br />Thanks!!Anonymoushttps://www.blogger.com/profile/15267163859614234723noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59404030350501975042017-09-18T06:43:50.174-05:002017-09-18T06:43:50.174-05:00aVR is 120 degrees and 150 degrees opposite aVL an...aVR is 120 degrees and 150 degrees opposite aVL and I, respectively. You should expect them to have reciprocal findings.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1490471721520685112017-09-17T19:46:54.563-05:002017-09-17T19:46:54.563-05:00Thanks for your clarification. May I also ask how ...Thanks for your clarification. May I also ask how should we interpret the STE in AVR and the down-sloping STD in Lead I and AVL (in the same ECG). ??Yasir Mohamedhttps://www.blogger.com/profile/14014138137901191943noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90693340221631406202017-09-12T14:42:50.777-05:002017-09-12T14:42:50.777-05:00No. The maximal ST depression is in right (not lef...No. The maximal ST depression is in right (not left) precordial leads. If right, then posterior (the STD is reciprocal to STE posterior Vector). If left, then the STD is primary, and STE in aVR is reciprocal to the ST depression (then it is LM, 3VD, but non-occlusive!) Make sense?Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35337909940857677632017-08-29T15:56:52.857-05:002017-08-29T15:56:52.857-05:00Thanks Dr Smith for the amazing blog and all the t...Thanks Dr Smith for the amazing blog and all the teaching.<br />I do have a question about the 2nd ECG<br />On a first look i would have said this is AVR STE with diffuse STD involving V2-6, Lead I, AVL, II and III (using T-P segment as the baseline).<br />wouldnt you call it LM insufficiency / TVD with diffuse subendocardial ischemia ??Yasir A/G (EM)noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16805664061032273182017-06-20T12:09:57.802-05:002017-06-20T12:09:57.802-05:00Kindly make a video if this if possible.. Thank y...Kindly make a video if this if possible.. Thank you.. 🙂 MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-31229909945103937472015-02-23T19:58:27.295-06:002015-02-23T19:58:27.295-06:00Any ECG must be evaluated in clinical context = yo...Any ECG must be evaluated in clinical context = your symptoms. Sometimes there is baseline benign ST depression, but I cannot comment on you. See your doctor.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87696222968589010562015-02-23T18:06:44.403-06:002015-02-23T18:06:44.403-06:00So just bc I have ST Depression on a resting Ecg d...So just bc I have ST Depression on a resting Ecg doesnt mean I have ischemia or CAD? I am so worried I have a blockage or I am going to have a stroke! :(Anonymoushttps://www.blogger.com/profile/09708254984852981909noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47297124915095665172015-01-17T13:38:38.774-06:002015-01-17T13:38:38.774-06:00Thank you x10000Thank you x10000Anonymoushttps://www.blogger.com/profile/09708254984852981909noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-33491756762612141422015-01-17T11:34:17.472-06:002015-01-17T11:34:17.472-06:00This comment has been removed by the author.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12763999683453885112015-01-16T22:04:51.399-06:002015-01-16T22:04:51.399-06:00This comment has been removed by a blog administrator.Heidinoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63198231898128460542014-10-10T09:36:02.114-05:002014-10-10T09:36:02.114-05:00These are manifestations of global subendocardial ...These are manifestations of global subendocardial ischemia, but not as pronounced as in case 1.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78872643504294500512014-10-07T10:48:42.955-05:002014-10-07T10:48:42.955-05:00Sir, ECG # 4 of 77 yrs old person having ST depres...Sir, ECG # 4 of 77 yrs old person having ST depression in V3 to V6. Is there subtle elevation in aVR and V1. If yes then what it signify?Equbal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59309502620076387852014-08-05T17:05:31.776-05:002014-08-05T17:05:31.776-05:00The ST axis is the direction that the ST vector po...The ST axis is the direction that the ST vector points to. If there is ST elevation anterior, then the ST vector is anterior. If the ST elevation is anterior and inferior, then the ST vector is anterior and inferior. If there is ST depression lateral, then the ST elevation vector is in the opposite direction, to the right. OK?Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37141632879559448462014-08-05T17:00:23.832-05:002014-08-05T17:00:23.832-05:00Dr. Gupta, I am very sorry I don't understand ...Dr. Gupta, I am very sorry I don't understand your question. Can you get someone to help you to formulate it more clearly?<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54690690238728868042014-08-05T06:01:30.461-05:002014-08-05T06:01:30.461-05:00Dear doctor what is st axis meansDear doctor what is st axis meansAnonymoushttps://www.blogger.com/profile/16218268439781983452noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84114052274170591662014-08-04T14:27:11.054-05:002014-08-04T14:27:11.054-05:00How to find st axis in lateral wall st depression ...How to find st axis in lateral wall st depression and where st axis fall in anterior lead st dippression.do we consider reciprocal changes of dippression as st axis.can one find st exis on ecg for each st depression or we should assume that if v5v6 is showing dippression and the patient is feeling immense symptoms without st axis change.is it rational to consider stems equivalent.or an st axis is necessary.please make topic clearAnonymoushttps://www.blogger.com/profile/16218268439781983452noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-56783984781508698062013-10-31T11:41:53.685-05:002013-10-31T11:41:53.685-05:00Good Question: R/S ratio is analogous to Q-waves a...Good Question: R/S ratio is analogous to Q-waves and is a later or chronic finding. It may help to make the diagnosis of acute posterior STEMI, if present, but if absent it is of no help.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39483236092273776942013-10-31T00:06:06.507-05:002013-10-31T00:06:06.507-05:00Thanks for your great explanations.
I'd like t...Thanks for your great explanations.<br />I'd like to ask about the posterior STEMI, do you include the R/S >1 in V2-3? Anonymoushttps://www.blogger.com/profile/00696129566615350737noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22020537315074960492013-09-11T14:19:59.378-05:002013-09-11T14:19:59.378-05:00My pleasure!My pleasure!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84384129714322703792013-09-11T12:20:16.727-05:002013-09-11T12:20:16.727-05:00Many thanks for the explanation !Many thanks for the explanation !RizkiAHhttps://www.blogger.com/profile/13526221066338054889noreply@blogger.com