tag:blogger.com,1999:blog-549949223388475481.post5160308297316111937..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Friday's post produced skeptics.....Unknownnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-549949223388475481.post-60037225105222101542013-12-19T21:19:08.414-06:002013-12-19T21:19:08.414-06:00Thanks, lot Ben
Thanks, lot Ben<br />Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34100667239954133662013-12-19T16:46:12.538-06:002013-12-19T16:46:12.538-06:00hi doctor
please keep posting ECGs, i've learn...hi doctor<br />please keep posting ECGs, i've learned so much, i recognized immediately the Inferior MI at the first glance when my sight " fell" on the disproportion of the QRS and T wave in DII, my though was enhaced by looking at the other leads, all that is due to reading your posts on this wonderful blog.<br /><br />greatings from algeria.bornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-81619610444098365842013-12-18T11:26:01.416-06:002013-12-18T11:26:01.416-06:00Thank you, Ken!Thank you, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19703396319204243032013-12-18T11:24:56.705-06:002013-12-18T11:24:56.705-06:00Scott,
Thanks for your comment!
SteveScott,<br />Thanks for your comment!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-75978149613669371562013-12-17T08:35:23.108-06:002013-12-17T08:35:23.108-06:00Thank you, Vittorio.Thank you, Vittorio.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35168727931149372172013-12-17T07:15:39.430-06:002013-12-17T07:15:39.430-06:00Hi Dr. Smith , ...Hi Dr. Smith , I thank you once again for the wonderful job that allows me and many of my colleagues to improve their knowledge. I visit your site every day and every day I discover something new.<br />Thanks for everything.<br />Vittorio<br />Anonymoushttps://www.blogger.com/profile/17960307225147640866noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55544432998131628922013-12-16T08:36:39.800-06:002013-12-16T08:36:39.800-06:00Dr. Celenk,
Thanks!
Steve SmithDr. Celenk,<br />Thanks!<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73267034821937212542013-12-16T08:35:13.091-06:002013-12-16T08:35:13.091-06:00Hyperkalemia manifests primarily in precordial lea...Hyperkalemia manifests primarily in precordial leads, so hyperacute T-waves and hyperkalemia are only a major diagnostic differential if seen in V2-V5. For medics, it is more difficult because you can't measure ST elevation. However, they really do look different but if is hard to explain. Hyperkalemia really has sharply peaked T-waves, as if pulled up by a string. They have a flatter ST segment. <br /><br />See these two posts: <br /><br />http://hqmeded-ecg.blogspot.com/2009/02/hyperacute-t-waves.html<br /><br />http://hqmeded-ecg.blogspot.com/2010/01/peaked-t-waves-hyperacute-stemi-vs.htmlSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40988681098492525572013-12-15T19:21:00.561-06:002013-12-15T19:21:00.561-06:00Steve,
What I can say in support of the skeptics ...Steve,<br /><br />What I can say in support of the skeptics is this:<br />I look at this ECG and it is an obvious inferior wall MI, and that is entirely a result of reading this blog over the years. Before I discovered your site, I never would have thought anything but non-specific findings as the intrerpretation.Scotthttps://www.blogger.com/profile/16364641167495330687noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-62859835511229590172013-12-15T14:29:09.628-06:002013-12-15T14:29:09.628-06:00Dear Dr. Smith,
I am very glad to have you as an...Dear Dr. Smith, <br /><br />I am very glad to have you as an excellent teacher of ECG. I read your every new post, and have started to read the older posts as well. I recommended your website to many people with praise. I also own your book from which I benefitted tremendously, and which I’d like to have on the market. <br /><br />Thank you very much.<br /><br />Mehmet K. Celenk, MD<br />mkcelenkhttps://www.blogger.com/profile/01271085321741539244noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14731454874451227732013-12-15T13:26:55.832-06:002013-12-15T13:26:55.832-06:00So I'm a paramedic with a few years experience...So I'm a paramedic with a few years experience now. I've looked at a couple of 12 leads but am really trying to get better and work at a higher level. I see a lot of "chatter" about hyper-acute T-waves. Can you describe the difference between a hyper-acute T-wave as an early change in MI and the peaked T-waves indicative of hyperK? Let's limit the conversation, if possible, to EKG changes and not return to the obvious importance of pt history and lab values. <br />Thanks<br />JasonAnonymoushttps://www.blogger.com/profile/11430385116634519300noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-66793286169616576142013-12-15T11:59:58.123-06:002013-12-15T11:59:58.123-06:00First - I would like to second all that Dr. Steve ...First - I would like to second all that Dr. Steve Smith says. I'm not sure if there is anyone in this country who has looked at as many difficult-to-interpret acute tracings in patients presenting with chest pain - for which they meticulously follow-up with serial tracings and catheterization confirmation.<br /><br />In my teaching of ECG interpretation - I stress the concept of "pattern recognition". There is a similar concept in radiology, which I believe is described as, "Aunt Minnie". You can verbally describe what aunt Minnie looks like for pages - but until you see her - you may not recognize her. So it is with pattern recognition in ECG interpretation. It is a "picture" - and the T waves in the inferior leads of this tracing convey that picture that I like to call, "HYPERACUTE T waves". These T waves are taller than they "should be" (ie, with respect to the relatively small QRS complexes in these leads). Note how these T waves are broader - almost as if these T waves are "trying" to elevate the ST segment. This is NOT normal. A look at lead aVL, which shows deeper-than-expected and more prominent negative T at the end of this sagging ST segment confirms that what is seen in the inferior leads is likely to be real and probably acute (esp. if the patient is having new-onset chest pain). BOTTOM LINE: Hyperacute T waves may be subtle - they are often a short-lived (transient) ECG sign - but one that is extremely important to recognize, because in the patient with new chest pain (esp. in association with reciprocal ST-T wave changes - as are seen here in aVL) - it means your patient is acutely infarcting from acute occlusion of a major coronary artery. THANK YOU for presenting this case Dr. Smith!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com