tag:blogger.com,1999:blog-549949223388475481.post3591031059831285604..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain, ST elevation, and negative serial trops: normal variant ("early repol"). Right?Unknownnoreply@blogger.comBlogger17125tag:blogger.com,1999:blog-549949223388475481.post-66926170520064749742019-04-07T15:15:37.407-05:002019-04-07T15:15:37.407-05:00Medical management is not appropriate for ruptured...Medical management is not appropriate for ruptured plaque with thrombus, which is what was found here. A stent is necessary.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-50681159375171701702019-04-06T05:46:37.067-05:002019-04-06T05:46:37.067-05:00Good case. Nondetectible troponins define a subgro...Good case. Nondetectible troponins define a subgroup with stable or relatively stable plaque and/or short CA spasm occuring spontaneously or inducible by activity, eating, anxiety, et. al. Patients with obstructive stable angina also have provocative ST elevation, positive NSTs, positive stress echos but usually without sufficient tournicut time for myocardial cell injury and enzyme release, ie, nondetectable or < 99% gender based cut-off troponins. The literature seems to support primarily medical management for this group. A new anginal pattern or rest angina relegates this patient into an unstable category. Lammerthttps://www.blogger.com/profile/14143360439917045347noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3747009631074053992018-01-15T09:53:44.938-06:002018-01-15T09:53:44.938-06:00Its possible in presence of Troponin Antibodies......Its possible in presence of Troponin Antibodies....such patients present with heart failure as well .. You should have sent tropinin antibodies ......google search for troponin antibodies .Anonymoushttps://www.blogger.com/profile/14287359274139842714noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80887801001845000702017-02-24T08:42:49.069-06:002017-02-24T08:42:49.069-06:00Every interventionalist is different! Echo would d...Every interventionalist is different! Echo would definitely be convincing.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32725443844289992842017-02-23T02:41:38.711-06:002017-02-23T02:41:38.711-06:00Would cath lab accepts initial ecg as stemi? if no...Would cath lab accepts initial ecg as stemi? if not, would echo with anterior akinesia convince unterventionist?maateeqhttps://www.blogger.com/profile/10063793989441938455noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49081500371425365942017-02-15T20:25:12.408-06:002017-02-15T20:25:12.408-06:00Allen,
It spontaneously lysed from 100% to 80%, an...Allen,<br />It spontaneously lysed from 100% to 80%, and did so fast enough that there was no myocardial necrosis (no elevated troponin).<br />Wellens' waves only occur when there is some infarction, often very little. But with no troponin elevation, one does not expect Wellens' waves.<br />STeveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65917474641032875092017-02-15T20:23:32.226-06:002017-02-15T20:23:32.226-06:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-20033500923315829592017-02-15T20:22:47.984-06:002017-02-15T20:22:47.984-06:00Not sure what you are sayingNot sure what you are sayingSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-26381064233356932252017-02-11T08:17:27.488-06:002017-02-11T08:17:27.488-06:00Dr. Smith:
The first ECG showed STEMI, which impli...Dr. Smith:<br />The first ECG showed STEMI, which implied 100% occluded LAD. I wonder if it is possible that the thrombus could be spontaneously lysed from 100% to 80%? Or, it was the 80% occluded LAD that could manifest as ''ST elevation'' in lead V1 to V4? And, if it was LAD spontaneously lysed from 100% to 80%, why there was no reperfusion T waves like the mechanism of Wellen's syndrome? <br />Thanks again for presenting this case!Anonymoushttps://www.blogger.com/profile/17513846747982914434noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2326479130492065702017-02-11T05:23:01.400-06:002017-02-11T05:23:01.400-06:00Wonderful case by Dr. Smith! I’ll add the followin...Wonderful case by Dr. Smith! I’ll add the following comments: i) I would not be expecting “Early Repolarization” as the explanation for this ECG in a man who is 58 and presenting with active chest pain at the time of this tracing (ie, early repol must be a diagnosis of exclusion in a patient this age presenting with active chest pain … ); ii) Although concave-up ST elevation may be seen in various lead areas when due to “early repolarization” — it is NOT typical to see 3mm of J-point ST elevation in lead V1, but none in inferior or lateral leads; iii) Early repol does not typically present with the “shape” of ST-T wave that we see in all anterior leads (more than 3mm of J-point ST elevation with disproportionately tall, peaked T waves); and iii) if this was pure “early repolarization” — I would NOT expect to see the FLAT ST segment that we clearly see in lead V6 … LOTS to learn from this case — THANKS to Dr. Smith for presenting! ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30421150873704683602017-02-10T12:22:44.094-06:002017-02-10T12:22:44.094-06:00the alternative to diagnose ischemic injury could ...the alternative to diagnose ischemic injury could be the administration of nitrates and the observation of the response in the pz?Anonymoushttps://www.blogger.com/profile/02421876450121897618noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-67173072181926209522017-02-10T11:16:29.624-06:002017-02-10T11:16:29.624-06:00Mario, of course. And that is why the QTc is long...Mario, of course. And that is why the QTc is longer than one would find in normal variant. It is the long QT that drives the formula to a high value.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39502413938266474502017-02-10T10:57:55.922-06:002017-02-10T10:57:55.922-06:00May I add that in the ECG#1 the anterior T waves a...May I add that in the ECG#1 the anterior T waves are alarmingly large ("fat"), as I have lerned repeteadly in this blog? <br />Many thanks for presenting this case!Mario Parrinellohttps://www.blogger.com/profile/07136945770330333718noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-56073930993232209872017-02-10T10:34:12.285-06:002017-02-10T10:34:12.285-06:00Al, yes, it looks like it. Sometimes the septal pe...Al, yes, it looks like it. Sometimes the septal perforator is distal to D1 and this is probably the case here, with occlusion distal to D1 (no STE in aVL, no STD in inferior leads) and proximal to S1 (large STE in V1)Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3893217049395785022017-02-10T10:32:22.919-06:002017-02-10T10:32:22.919-06:00Uncommon, but I've seen it many times. I have...Uncommon, but I've seen it many times. I have not found any papers on the topic. This was not only negative troponins, but UNDETECTABLE!!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65215280789717799692017-02-10T09:54:41.025-06:002017-02-10T09:54:41.025-06:00It would be interesting to know if this occlusion ...It would be interesting to know if this occlusion was distal to 1. diagonal but proximal<br />to 1. septal branch<br />Merci Dr Smith !<br /><br />AlAlswissnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83764833799959518852017-02-10T08:23:52.348-06:002017-02-10T08:23:52.348-06:00Dear Dr Smith
How frequent is this phenomena of NE...Dear Dr Smith<br />How frequent is this phenomena of NEGATIVE SERIAL TROP with Unstable Angina or Impending big Anterior STEMI as observed in the index case ?<br />Dr Rajiv AroraDr.Rajiv Arorahttps://www.blogger.com/profile/11328692379948981426noreply@blogger.com