tag:blogger.com,1999:blog-549949223388475481.post4697525430065045790..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.Unknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-549949223388475481.post-28741599937156343972020-04-30T09:37:06.357-05:002020-04-30T09:37:06.357-05:00Hi. When there are 10 tracings, none of which are ...Hi. When there are 10 tracings, none of which are numbered — it is always difficult for me to know WHICH one(s) you are referring to ... But IF you are asking about the 1st ECG — NO, I do not believe that extra notching is an Osborn wave. Instead (as per Dr. Smith) — it seems to be part of the QRS complex. An Osborn wave is an accentuated J-point (occurs after the QRS) — and you should see it more consistently in more leads than we do here ... — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72504844380538524262020-04-30T08:09:12.102-05:002020-04-30T08:09:12.102-05:00Is that osborn wave / j wave which looks like ST e...Is that osborn wave / j wave which looks like ST elevation?Anonymoushttps://www.blogger.com/profile/14974855447137722291noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74411292813895849732020-04-30T00:12:11.223-05:002020-04-30T00:12:11.223-05:00YES — The PVCs in the examples you mention do mani...YES — The PVCs in the examples you mention do manifest marked ST elevation in some leads. That said — this occurs amidst a background of Torsades de Pointes and truly bizarre-looking PVCs — so I wouldn’t focus on ST segment deviations in these bizarre-morphology PVCs. Optimal treatment of Torsades (in addition to IV Mg++) includes identifying and “fixing” (if at all possible) the underlying cause — after which you can repeat the ECG to see if underlying ST elevation is still present. As to your other questions — I see QRS widening in the first 3 ECGs. Perhaps some of this is post-resuscitation related. In My Comment (above, at the bottom of the page — which I added AFTER you asked these questions) — I discuss the discrepancy between what looks to be a normal QT vs a long QT for ECG #4 in my Figure-1 (the tracing done 1 hour later). The end limit of the T wave is just not clear in virtually all leads — but I agree with Dr. Smith, that in lead V2 (PURPLE arrow in my ECG #4) — the QTc truly appears prolonged (and this is more than just addition of a U wave to the end of the T wave). I hope the above addresses your concerns — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38938234079305098232020-04-29T14:54:41.807-05:002020-04-29T14:54:41.807-05:00Hello DR. Smith, 2 questions:
-This blog has taug...Hello DR. Smith, 2 questions:<br /><br />-This blog has taught us, many times in the previous posts, that PVCs can "reveal" an ongoing AMI by showing ST anomalies which may be less evident in native QRS complexes. So, especially if I look at ECGs 1 and 4 in your final examples, i notice changes which I would for sure interpret as ischemic if I didn't know that wasn't the case. So, question is: how do we tell the difference? Maybe because there's also a long QT in native beats? Or because in native beats there is ZERO STE/STE compared to PVCs? <br /><br />-About the fourth ECG (the one which was recorded "1 hour later") QT sure looks very long if you look at leads V1 and V2, but it is kinda short looking at lead DII; plus, i can clearly see U waves in lead V4: is it possible that the long QT interval observed in leads V1 and V2 represents U waves merging with T waves? That would explain why QT in lead DII looks short. Also, I remember one post in this blog which stated that drugs may cause long QT, but NOT U waves (as in, long QU interval): if i remember right, so, tox consult was right about not accounting this on Chloroquine.<br />And.. why, in the first ECG (but not in the others) QRS is WIDE too, which is not a feature of hypokalemia? Is this some conduction disturbance in the post-ROSC state, or what?<br /><br />Thank you! Anonymousnoreply@blogger.com