tag:blogger.com,1999:blog-549949223388475481.post5236600209834923309..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A Tough ECG, But Learn From It!Unknownnoreply@blogger.comBlogger16125tag:blogger.com,1999:blog-549949223388475481.post-46223930697649289272018-09-16T08:17:35.592-05:002018-09-16T08:17:35.592-05:00Myles,
Yes. Good observations!
You are an astute r...Myles,<br />Yes. Good observations!<br />You are an astute reader of ECGs.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1021791385140025682018-09-12T19:52:22.588-05:002018-09-12T19:52:22.588-05:00I have a question regarding the seemingly proporti...I have a question regarding the seemingly proportionally large T wave in lead II, my interpretation is that the QRS axis is somewhere along -30 which would lead to a diminutive or biphasic complex in lead II where as the T wave axis is somewhere around +30 degrees which would lead to normal morphology and sized T waves in II. <br /><br />Secondly it appears to me that there is some suggestion that the patient had a previous inferior MI, with QS waves and QRS fragmentation in leads III and aVF. Would you agree with that assessment?Myles Tuchschererhttps://www.blogger.com/profile/13386981715607815505noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-64225011252279064712017-10-11T16:57:49.692-05:002017-10-11T16:57:49.692-05:00I agree the T-wave in lead II is a bit proportiona...I agree the T-wave in lead II is a bit proportionally large. Not sure if it is related to this LAD occlusion. This case would easily be identified using the LAD-normal variant formula.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17319859786611239532017-10-11T16:48:01.971-05:002017-10-11T16:48:01.971-05:00ECG 1.... Lead 2 has a comparatively tall T wave(l...ECG 1.... Lead 2 has a comparatively tall T wave(low voltage of QRS) any comments on that??? many times this is seen in patients with non cardiac symptoms... Links to any posts which addresses these issues???? Thank youMGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61125114578277904282015-11-23T12:30:52.753-06:002015-11-23T12:30:52.753-06:00Sam,
Not similar at all.
In the case you refer to,...Sam,<br />Not similar at all.<br />In the case you refer to, there are no other signs of prolonged persistent occlusion, particularly QS-waves. In the case you mention, there are no Q-waves at all, so it doesn't even approach minimally prolonged occlusion. Again, in the case you mention: it is the first ECG after chest pain resolves, it was short duration chest pain, there are no Q-waves, so this is NOT the shallow inversion of prolonged occlusion.<br />Capiche?<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60910969761346619862015-11-14T19:06:15.059-06:002015-11-14T19:06:15.059-06:00Seems to be a lot of potential overlap!
For ex:
T...Seems to be a lot of potential overlap!<br /><br />For ex:<br />The terminal T-wave inversions in this case (persistent occlusion) look very very similar to the terminal T-wave inversions from this case:<br /><br />http://hqmeded-ecg.blogspot.com/2013/11/why-we-need-12-lead-st-segment.html (artery open)<br /><br />Anonymoushttps://www.blogger.com/profile/09692498213534558770noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-48239485788563285122015-11-14T10:14:06.155-06:002015-11-14T10:14:06.155-06:00No, even with persistent occlusion, eventually sha...No, even with persistent occlusion, eventually shallow (as opposed to deep) T-wave inversion evolves.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65664062952606607432015-11-13T15:52:32.057-06:002015-11-13T15:52:32.057-06:00Excellent Diagram, Steve! But it seems this termin...Excellent Diagram, Steve! But it seems this terminal inversion only seems to generally represent evolution in the direction of reperfusion (as opposed to persistent occlusion)? I suppose there must be great variation.Anonymoushttps://www.blogger.com/profile/09692498213534558770noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36810025505178601882015-11-12T14:40:05.892-06:002015-11-12T14:40:05.892-06:00Sam, with prolonged occlusion and transmural myoca...Sam, with prolonged occlusion and transmural myocardial infarction, T wave inversion eventually evolves. It happens more slowly than with reperfusion and does not become as deep.<br /><br /> Look at the schematic on the upper right corner of page 50 of my book:<br /><br />http://traffic.libsyn.com/emcrit/ECG_in_Acute_MI_The_-_Unknown.pdfSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53101845351580300072015-11-12T12:43:55.701-06:002015-11-12T12:43:55.701-06:00Steve,
Any explanation for the terminal T-waves in...Steve,<br />Any explanation for the terminal T-waves inversion (Wellen's-like waves) in the precordial leads on the 2nd ECG where the vessel was apparently closed?<br /><br />SamAnonymoushttps://www.blogger.com/profile/09692498213534558770noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36139247972952115942013-06-22T08:22:02.663-05:002013-06-22T08:22:02.663-05:00Good Question. I would be much less worried. I w...Good Question. I would be much less worried. I would have to evaluate on a case by case basis, and take a thorough history.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-799169433504384742013-06-21T20:37:38.528-05:002013-06-21T20:37:38.528-05:00Dr Smith,
What would be your thoughts on this ECG ...Dr Smith,<br />What would be your thoughts on this ECG if the pt had presented with no symptoms suggestive of myocardial ischaemia?<br /><br />AndyJhttps://www.blogger.com/profile/08742812483232241614noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38819010139929482022013-06-19T09:23:26.316-05:002013-06-19T09:23:26.316-05:00Yes, III and aVF is what I meant to say. Thanks!Yes, III and aVF is what I meant to say. Thanks!Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68999588570335915002013-06-19T06:47:07.079-05:002013-06-19T06:47:07.079-05:00Pendell,
Did you mean III and aVF? Yes, there are...Pendell,<br />Did you mean III and aVF? Yes, there are "down-up" biphasic T-waves and these are very suspicious for ischemia.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32076558506883709732013-06-19T00:57:11.037-05:002013-06-19T00:57:11.037-05:00Fantastic teaching points.
One question: what do...Fantastic teaching points. <br /><br />One question: what do you think about the ST segments in leads II and III in the presenting ECG? Though there is no ST depression at the J point, they have downsloping, straight contour with terminal T wave inversion (upright in this case) that strikes me as reciprocal changes.<br /><br />Other than the poor R wave progression and symmetric T waves in the LAD distribution, this was the most worrying feature to my eyes since I was looking for reciprocal changes in these leads to help figure out whether this was LAD occlusion or not. <br /><br />What do you think?Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-24173531001661396792013-06-19T00:19:52.206-05:002013-06-19T00:19:52.206-05:00Yet another great case! Thank you very muchYet another great case! Thank you very muchAnonymoushttps://www.blogger.com/profile/04177077288537463527noreply@blogger.com