tag:blogger.com,1999:blog-549949223388475481.post5567986303517667750..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Chest pain, ST Elevation, and tachycardia in a 40-something womanUnknownnoreply@blogger.comBlogger9125tag:blogger.com,1999:blog-549949223388475481.post-43329730208418745322021-04-07T05:23:52.189-05:002021-04-07T05:23:52.189-05:00niceniceVishal Sharmahttps://www.blogger.com/profile/08861709834808119636noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39706230699886051942021-02-14T09:01:11.287-06:002021-02-14T09:01:11.287-06:00Excellent reference! Thank you!
QR in V1 – an EC...Excellent reference! Thank you!<br /><br />QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism.<br /><br />Aims: To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome.<br /><br />Methods and results: ECG's from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism. Qr in V(1)(14 vs 0 in controls; p<0.0001) and ST elevation in V(1)> or =1 mV (15 vs 1 in controls; p=0.0002) were more frequently present in patients with pulmonary embolism. Sensitivity and specificity of Qr in V(1)and T wave inversion in V(2)for predicting right ventricular dysfunction were 31/97% and 45/94%, respectively. Three of five patients who died in-hospital and 11 of 20 patients with a complicated course, presented with Qr in V(1). After adjustment for right ventricular strain including ECG, echocardiography, pro-brain natriuretic peptide and troponin I levels, Qr in V(1)(OR 8.7, 95%CI 1.4-56.7; p=0.02) remained an independent predictor of adverse outcome.<br /><br />Conclusions: Among the ECG signs seen in patients with acute pulmonary embolism, Qr in V(1)is closely related to the presence of right ventricular dysfunction, and is an independent predictor of adverse clinical outcome.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61332027427616252502021-02-14T08:56:33.907-06:002021-02-14T08:56:33.907-06:00SPO2 was excellent during chest compressions (for ...SPO2 was excellent during chest compressions (for a cardiac arrest case), as was pulse, which made us think that there could not be pulmonary artery obstruction, as we were getting good flow and Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76638951446585549742021-02-14T08:54:31.844-06:002021-02-14T08:54:31.844-06:00Certainly would consider it, but in the context of...Certainly would consider it, but in the context of Non-shockable rhythm, PE climbs higher on the differential diagnosis.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41894063841545539992021-02-01T23:44:09.784-06:002021-02-01T23:44:09.784-06:00Hi Dr Smith, with this particular ECG , wouldn’t y...Hi Dr Smith, with this particular ECG , wouldn’t you consider the possibility of old ASMI( poor R IN V1-V3 with residual ST ELEVATION) with now ST elevation in aVR due to left main disease or severe TVD.. severe ischemia leading to tachycardia later leading to asystoleRaghuhttps://www.blogger.com/profile/10175220317591499361noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88923387359476952842021-02-01T10:38:08.223-06:002021-02-01T10:38:08.223-06:00Dr.Smith,thanks for this excellent but challenging...Dr.Smith,thanks for this excellent but challenging ECG of 40 something woman with chest pain, ST elevation and tachycardia ( 30th JAN 2021 ) I fully agree with your very valid point on tachycardia<br />in suspected ACS. Also, I think the diagnostic thinking in this emergency case would have included PTE had the refering team looked at patient's SPO2. Ofcourse, the ECG is arguably compelling enough to rush towards ACS. <br />with regards, Dr.R.Balasubramanian. PONDICHERRY, INDIA<br /><br />dr. R.Balaubramanianhttps://www.blogger.com/profile/10882266041266448279noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85108574903969597012021-01-31T15:17:56.561-06:002021-01-31T15:17:56.561-06:00What a lovely reminder of PE in this ECG very susp...What a lovely reminder of PE in this ECG very suspicious for ischemia. <br />Some salient notes, <br />Thank you from ZAA. Rouxhttps://www.blogger.com/profile/07902575656226326605noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82856585848370133802021-01-31T06:38:20.018-06:002021-01-31T06:38:20.018-06:00thank you, Steve. Sad case, but very enlightening...thank you, Steve. Sad case, but very enlightening. interesting that TEE was not terribly helpful, and that full dose tPA ineffective. <br />Steve... there wasn't just ST elevation V1-3. there was significant ST depression inferior and laterally. thus, global ischemia? Is this simply RV injury pattern with reciprocal changes elsewhere, or ischemia elsewhere? tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-77391824837433363862021-01-31T04:46:00.390-06:002021-01-31T04:46:00.390-06:00https://pubmed.ncbi.nlm.nih.gov/12804925/
QR in V1...https://pubmed.ncbi.nlm.nih.gov/12804925/<br />QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism急診熊https://www.blogger.com/profile/14319887376579106556noreply@blogger.com