tag:blogger.com,1999:blog-549949223388475481.post318860414626405875..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A middle aged man with ST depression and a narrow window of opportunityUnknownnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-549949223388475481.post-41978340200478863362018-05-25T20:49:42.056-05:002018-05-25T20:49:42.056-05:00I am not sure whether there was a bedside echo don...I am not sure whether there was a bedside echo done before cath. I cannot find one.Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40503557562578634622018-05-21T11:58:57.395-05:002018-05-21T11:58:57.395-05:00Great case!
Did the patient get an echo before c...Great case! <br /><br />Did the patient get an echo before cath? Lsrhttps://www.blogger.com/profile/15571346944768179324noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80677590823363037532018-05-21T05:15:04.769-05:002018-05-21T05:15:04.769-05:00Great post.ThanksGreat post.ThanksAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30603681127090614002018-05-20T15:44:09.058-05:002018-05-20T15:44:09.058-05:00Excellent, thanks Ken!Excellent, thanks Ken!Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43667849325742756062018-05-20T15:43:28.767-05:002018-05-20T15:43:28.767-05:00Not sure what you mean, please explain your questi...Not sure what you mean, please explain your questionPendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-45279991513886282502018-05-20T15:43:10.668-05:002018-05-20T15:43:10.668-05:00We have had many such cases on the blog previously...We have had many such cases on the blog previously with occlusions of LCX, OM1, diagonals, etc. Look back at these cases for examples. If you mean distinguishing LCX from OM or from diagonal occlusions, this can be very difficult as the arterial supply is variable in this area. There are some patterns that can be recognized, such as the "mid-anterolateral" occlusion which is usually a diagonal, but this is just not definite enough to say that I could distinguish these particular vessels reliably. Only cath will tell!Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10962819246164352822018-05-20T13:34:58.138-05:002018-05-20T13:34:58.138-05:00Excellent case by Pendell Meyers! I’ll add 2 comme...Excellent case by Pendell Meyers! I’ll add 2 comments: i) On the initial ECG (that Dr. Meyers received at 18:13) — the SHAPE of the ST segment in lead V6 is coved! I have always believed that “shape” is more important than amount, and this shape for the ST segment in lead V6 (in conjunction with what we see in the anterior leads), is perfectly consistent with acute LCx occlusion; and ii) I suggest use of my “Mirror Test” to facilitate recognition of the shape of ST-T wave deviation indicating acute posterior infarction. To do a “Mirror Test” — simply flip the ECG over, and hold it up to the light. Doing so in this case, would produce coved ST elevation with beginning symmetric T wave inversion, especially in lead V2 (that looks like an acute ST elevation MI). Given how localized the ST-T wave changes in this 1st ECG are (maximal in V2,V3) — this picture should suggest acute posterior MI until proven otherwise (clearly, a “STEMI-equivalent” = OMI). THANKS again to Dr. Meyers for presenting this case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-89770039699428111412018-05-20T10:45:44.534-05:002018-05-20T10:45:44.534-05:00Really well presented and informative case. The us...Really well presented and informative case. The use of OMI as opposed to STEMI and NonSTEMI really proves a point on this case I feel.Phil Smithnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84181641815822955952018-05-20T10:10:46.451-05:002018-05-20T10:10:46.451-05:00So, I suppose this begs the following question: A...So, I suppose this begs the following question: At what point could/should the ED physician simply decide to give lytics in this situation? Would doing so have potentially changed this patient's outcome? Would love to hear thoughts on this from my fellow ED colleagues.Anonymoushttps://www.blogger.com/profile/02096922794079076025noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41017420736097884972018-05-20T08:47:22.373-05:002018-05-20T08:47:22.373-05:00Great post and great explanation! I am kinda confu...Great post and great explanation! I am kinda confused because of the not so steep initial positive deflection of the R wave. George Konstantinouhttps://www.blogger.com/profile/17537635350617697691noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18926357556950196322018-05-20T07:09:35.700-05:002018-05-20T07:09:35.700-05:00I'm still surprised how hard it is sometimes t...I'm still surprised how hard it is sometimes to convince certain cardiologist of STEMI. I agree 100% that the guidelines are misguiding. I feel that i have more luck convincing them when i can argue that i think a certain vessel is occluded. Say for instance subtle high lateral infarcts. Therefore i have a request. Would you be bothered to make a post on how to distinguish infarcts of Cx, obtuse marginal and diagonal branch. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30756287368989372532018-05-20T06:09:54.569-05:002018-05-20T06:09:54.569-05:00excellent case, Pendell, with very good cath photo...excellent case, Pendell, with very good cath photos and descriptions.<br /><br />my partner and i had a similar case a few nights ago,equally frustrating, an obvious major vessel acute occlusion, , but not by "classic" STEMI criteria, so they didn't cath her immediately, and she bumped trop's. she was 39, severe chest pain.<br />its somewhat surprising that in 2018 there isn't a generally greater awareness of STEMI equivalents.<br />thank you for this case. i am disheartened by the outcome.<br /><br />tomtom fieronoreply@blogger.com