tag:blogger.com,1999:blog-549949223388475481.post4582694986551878744..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: 45 year old with chest painUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-14402914697385920342014-02-05T16:17:52.122-06:002014-02-05T16:17:52.122-06:00The Grace score would not have been very high beca...The Grace score would not have been very high because at the time it would be applied, he had normal vital signs and no previous medical history.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60161327237531948002014-02-05T15:36:34.534-06:002014-02-05T15:36:34.534-06:00Very instructive case! What about Grace score? A G...Very instructive case! What about Grace score? A Grace score > 140 is associated with high mortality during first week and at 6 month so this kind of patient must be monitored/treated in hospital. Also, patients with unstable angina with intermediate score have to be assessed by treadmill ecg test or strain echo in the next 2-3 days.Anonymoushttps://www.blogger.com/profile/00681169174907303228noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83085762042819017792014-01-29T07:11:15.195-06:002014-01-29T07:11:15.195-06:00Yes, looks like an old inferior MI, but I don'...Yes, looks like an old inferior MI, but I don't think there was any other evidence of it.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77302586534528757902014-01-28T15:20:21.702-06:002014-01-28T15:20:21.702-06:00hi doctor
it's always instructive and a pleasu...hi doctor<br />it's always instructive and a pleasure to read your posts, my question is about the Q wave present II and AVF on the ipresenting ECG ,? what is their signification ? why we don't assume they're due to ischemia ?<br />thank youbornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34594962887848159732014-01-26T20:58:48.635-06:002014-01-26T20:58:48.635-06:00David,
the apex is usually involved in LAD occlusi...David,<br />the apex is usually involved in LAD occlusion, but does NOT usually have involvement of lead II, as here. I'm not sure why there is that finding, but good observation. There certainly was proximal LAD occlusion with anterolateral STEMI (I, aVL). But lead II? Not certain.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51497103032868262892014-01-26T20:38:41.161-06:002014-01-26T20:38:41.161-06:00Dr. Smith,
In the first ECG, there appears to be s...Dr. Smith,<br />In the first ECG, there appears to be subtle ST elevation in lead II, and in the third ECG, there is again T wave inversion in lead II in addition to the others mentioned... It leaves me wondering if the apical wall is also affected?<br /><br />thank you,<br />DavidDave Bhttps://www.blogger.com/profile/04348546121665459931noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-70794257072536818852014-01-26T18:15:21.851-06:002014-01-26T18:15:21.851-06:00Pendell,
I've always thought of absence of S-w...Pendell,<br />I've always thought of absence of S-wave as pretty normal in V5 and V6, but I'll have to pay more attention to that now. It is definitely abnormal to not have an S-wave in V2 and V3, but here they are present. You may be on to something. I'm not sure!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46159340071004056472014-01-26T15:37:37.072-06:002014-01-26T15:37:37.072-06:00On the presenting ECG, lead V5:
My eyes tell me t...On the presenting ECG, lead V5: <br />My eyes tell me that there is QRS distortion there (especially the middle complex), despite not meeting the current definition. To my eyes the ST elevation has invaded into the QRS complex and raised/obliterated the S wave. In fact, the "S-wave", if it is even actually present, doesn't even extend appreciably past the baseline - meaning it almost can't be called an S-wave. <br /><br />This finding is absent in all the subsequent ECGs. In my very little and unqualified experience, this strikes me as potentially specific for acute occlusion (STEMI). I have yet to be mislead by this.<br /><br />What do you think? Do you think we need a new definition of "QRS distortion"?Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-69139088034798772412014-01-26T13:46:37.575-06:002014-01-26T13:46:37.575-06:00Nice comments. Of course the typical pain gets ig...Nice comments. Of course the typical pain gets ignored because of the age (which should not dissuade!)Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16351168095232328482014-01-26T13:43:46.459-06:002014-01-26T13:43:46.459-06:00Thank you for this marvelous case.
There is some t...Thank you for this marvelous case.<br />There is some things i'd like to add. You wrote about troponin concentrations, ECG changes, Echo picture, but in my opinion in this case most important is clinical feature. There is a man with chest pain (pressure) associated with physical exercise and is releaved by nitroglycerine. So you have typical angina - what more for diagnosing UA?<br />Dynamic ECG picture is added value (less ST-elevation is not connected with change of rhythm so it is rather not caused by early repolarisation). <br />And one more thing. If you look carefully at I, II you can see PR depression with reflective PR elevation in aVR that persists in the other ECG - maybe kind of atrial ischemia or just my imagination ;)Anonymoushttps://www.blogger.com/profile/04099431898616523988noreply@blogger.com