tag:blogger.com,1999:blog-549949223388475481.post3179675711286272189..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A 40-something male with epigastric painUnknownnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-549949223388475481.post-90645930656167028442020-05-04T22:22:29.515-05:002020-05-04T22:22:29.515-05:00@ AKS — Thanks for your question! As I suggested i...@ AKS — Thanks for your question! As I suggested in my comment just above your question — “A repolarization variant with a variable pattern on serial tracings is clearly a diagnosis of exclusion”. Part of the process of exclusion (ie, to rule out underlying structural hearts disease, as per your question) would be getting an Echo.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-5650231459556227342020-05-04T18:21:49.298-05:002020-05-04T18:21:49.298-05:00Ken..doesn't the t wave inversion pattern res...Ken..doesn't the t wave inversion pattern resembles apical cardiomyopathy ??AKShttps://www.blogger.com/profile/02154650740617806061noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-69279962115799908182018-02-27T07:44:43.061-06:002018-02-27T07:44:43.061-06:00No. ECG is normal. EDACS score very low. All tr...No. ECG is normal. EDACS score very low. All trops neg. Does not need further workup!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38423797927898291862018-02-26T12:52:44.513-06:002018-02-26T12:52:44.513-06:00Did you plan further non-invasive investigation fo...Did you plan further non-invasive investigation for this patient? like CCTA?Ali TMnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47908124238851255712018-02-02T14:54:48.007-06:002018-02-02T14:54:48.007-06:00I can see why you say that, but this is a very spe...I can see why you say that, but this is a very specific morphology, a normal variant.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18931371471403831232018-02-02T08:19:22.116-06:002018-02-02T08:19:22.116-06:00It looks a bit like LVH. Doesn't it?It looks a bit like LVH. Doesn't it?Nadav shouahttps://www.blogger.com/profile/17330808847744006766noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-21164211462048485662018-01-25T06:12:37.967-06:002018-01-25T06:12:37.967-06:00I measure the QT at just over 400. The computer m...I measure the QT at just over 400. The computer measured 413. I think you're including the U-wave in your measurement? There was no hypokalemia. U-waves are normal in early repolarization!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8293427687071378682018-01-25T06:06:50.686-06:002018-01-25T06:06:50.686-06:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-42655077799356014182018-01-25T01:59:42.151-06:002018-01-25T01:59:42.151-06:00Thank you for your answer!
I looked at the ecg ag...Thank you for your answer!<br /><br />I looked at the ecg again and i found that the QTc is rather long (480 if i measured correctly) and there appear to be some u-waves in V2-V5. <br />In case my observations are correct : Is it possible that these changes are due to BER or is there maybe some hypokalemia?<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54200618815267677332018-01-24T22:20:04.084-06:002018-01-24T22:20:04.084-06:00Wonderfully insightful case. I also thought ECG #1...Wonderfully insightful case. I also thought ECG #1 was more likely to represent early repolarization — because: i) the totally rounded ST-T wave in lead V2, especially in context with the prominent J-point at the onset of the ST segment in lead V3 just “didn’t look like” a stemi pattern; ii) although there is ST elevation in lead aVL (and the opposite picture in the inferior leads) — the prominent J-point notching in lead aVL again just looks like early repolarization; iii) QRS amplitude is markedly increased in the anterior leads (with transition already by V1-to-V2) — whereas one typically expects diminished R wave progression when there is anterior stemi. That said, ample voltage for LVH is present in this 40yo man (R in V5>25; R in V6>20) — and the ST-T wave changes in lateral chest leads to me suggests LVH more than early repolarization …<br /><br />ECGs #2 and #3 show definite change compared to ECG #1. I would definitely be much more concerned if the ONLY ECG I saw in this patient was ECG #3. And although ST-T wave changes can vary even in patient with early repolarization — a repolarization variant with a variable pattern on serial tracings is clearly a diagnosis of exclusion. In addition, it is possible to have a “baseline” consisting of a repolarization variant + LVH, with an acute evolving event on top of that … That’s why it is so helpful in this case to be told of the follow-up from Dr. Smith that serial troponins remained below the detectable level — thus confirming (by exclusion) that no acute cardiac process was ongoing. THANKS for presenting this superb case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-5939528942391111572018-01-24T15:41:37.144-06:002018-01-24T15:41:37.144-06:00Thanks. Mostly because I recognize the pattern. ...Thanks. Mostly because I recognize the pattern. It is difficult to say why. As I say in the post, so much is like recognizing a face.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59783571655546019112018-01-24T14:21:12.020-06:002018-01-24T14:21:12.020-06:00Hi Dr.Smith,
thank you for your great blog!
I im...Hi Dr.Smith,<br /><br />thank you for your great blog!<br /><br />I immediately saw the early repol pattern in V3 (s-wave and j-wave), but the inverted t-waves in the inferior leads and the missing early repol pattern in v1-v2 made me unsure if this is some ischemia superimposed on early repol.<br />Is there a way to be sure that is not the case? What made you so sure it is just early repol? After all , the patient was having cpAnonymousnoreply@blogger.com