tag:blogger.com,1999:blog-549949223388475481.post3475915120027409250..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Status epilepticus. What is this ECG pathognomonic of?Unknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-82934326868079236572019-11-19T18:48:26.774-06:002019-11-19T18:48:26.774-06:00@ Unknown — In answer to your question, I tried to...@ Unknown — In answer to your question, I tried to illustrate how to measure the QT when the U wave overlaps (PURPLE arrow in lead V2 of ECG #1 in Figure-1 of My Comment above). This is admittedly challenging to do in the above case — because the ONLY lead in which I clearly see definition of the U wave from the preceding T wave is lead V2 — but, the BLACK line leading to the PURPLE arrow at the ST-T wave baseline suggests where the T wave would terminate, if there was no overlapping U wave — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1399361404934823842019-11-19T13:09:17.638-06:002019-11-19T13:09:17.638-06:00INTERESTING tracing and your explanation was very ...INTERESTING tracing and your explanation was very useful for me, Thanks! But how can i measure the QT interval when there are U waves that overlap with the terminal portion of the T wave?Is there a QT interval or QU interval? O Poder da Eletrocardiografiahttps://www.blogger.com/profile/11143192155299060176noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-47336551213601326842019-11-19T11:37:46.800-06:002019-11-19T11:37:46.800-06:00@ Jak nie zginac — THANK YOU for your comment. I m...@ Jak nie zginac — THANK YOU for your comment. I most definitely do NOT think otherwise healthy individuals who manifest U waves on an otherwise normal ECG need to have serum K+ checked (Please see NOTE #1 in My Comment above, in which I emphasize that U waves are NOT specific for hypokalemia — and that in addition to being common with LVH or bradycardia, U waves may also be seen as a normal finding). I saw U waves ALL the time during the 30 years that I overread all ECGs for 35 providers in our primary care clinic — and I felt comfortable recognizing when this finding was of unlikely significance. It is when you see very large U waves (comparable or larger in size to the T waves that precede them) in association with ST-T wave flattening and/or slight depression in a patient with a potential predisposing factor to electrolyte imbalance (such as was the situation in the case of this patient with seizures, and his initial tracing = ECG #1) — that I then suspect low K+ and/or low Mg++. Thanks again for your comment! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23620636616586789572019-11-19T07:07:24.078-06:002019-11-19T07:07:24.078-06:00There are lots of U wave on V2-V3 leads in young h...There are lots of U wave on V2-V3 leads in young healthy athletes (6-14 yo). U shape is typical, without brady and LVH. Do you think do they need to potassium level check? Jak nie zginac w Zjednoczonym Królestwiehttps://www.blogger.com/profile/02208410398053595532noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-48578204879171717712019-11-19T06:51:03.013-06:002019-11-19T06:51:03.013-06:00@ Unknown — YES, it is true that the extra deflect...@ Unknown — YES, it is true that the extra deflections that we see in leads V2 and V3 of ECG #1 look “a little bit” like AFlutter — but they are NOT flutter waves. The ways to KNOW this are: i) To use CALIPERS (I illustrate exactly how to do this in Pearl #4 of the Nov. 12, 2019 post on Dr. Smith’s ECG Blog — GO TO — https://hqmeded-ecg.blogspot.com/2019/11/what-is-this-regular-svt.html ). If you carefully measure those deflections (best seen in lead V3 of ECG #1) — they are NOT precisely equi-distant, one from another (atrial flutter is a VERY precisely regular rhythm!); ii) If by chance these deflections were precisely regular — then I count 4:1 AV conduction (the 4th deflection would be hidden within the QRST) — but since the ventricular rate is ~100/minute, this would mean that the atrial would have to be firing at a rate of ~400/minute — and THAT is way too fast for AFlutter!; and iii) Although these deflections are seen in V2,V3 — they are NOT seen in the other 10 leads — and you can almost always (IF you look carefully enough WHILE using your calipers) find evidence of AFlutter in MORE than just 2 leads — AND — the BEST leads for finding flutter waves (also discussed in the Nov. 12 post) are leads II, III, aVF, aVR and V1 — so it would be VERY unusual to ONLY see AFlutter in leads V2 and V3 — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37339363550618790092019-11-18T23:20:47.852-06:002019-11-18T23:20:47.852-06:00The T, U, P wave in V2 and V3 look a little bit li...The T, U, P wave in V2 and V3 look a little bit like "sawtooth" wave in atrial flutter. How can we make sure this is not atrial flutter?Soacashttps://www.blogger.com/profile/01893806133096836875noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-58447607430157350302019-11-18T22:04:27.555-06:002019-11-18T22:04:27.555-06:00@ bxZ — If the reference you are making is to the ...@ bxZ — If the reference you are making is to the finding of a S1Q3T3 — ECG #1 (in my Figure-1 above) lacks the T3 (ie, there is no clear T wave inversion in lead III). For whatever assistance the finding of a true S1Q3T3 might provide in the diagnosis of acute pulmonary embolism — there is NO diagnostic assistance if ANY one of the 3 components (an S wave in lead 1 — a Q wave in lead III — T wave inversion in lead III) is missing.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17823817489510322982019-11-18T14:12:11.169-06:002019-11-18T14:12:11.169-06:00s1q3s1q3bxZhttps://www.blogger.com/profile/05847761540046573420noreply@blogger.com