tag:blogger.com,1999:blog-549949223388475481.post6185781196055255605..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: CO poisoning. Routine ECG recorded before hyperbaric therapy....Are they related?Unknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-549949223388475481.post-30868545430234520092019-12-15T21:31:53.254-06:002019-12-15T21:31:53.254-06:00@ Unknown — Thank you for your comment. At the lea...@ Unknown — Thank you for your comment. At the least — there IS definite (if not dramatic) T-QRS-D in lead V3. In fact, the lowest point of the QRS descent is 4-5mm ABOVE the baseline in this lead V3! It is 3-4mm above the baseline in lead V2 — but technically, I agree with you that there IS a small J-notch in lead V2 — so lead V2 does not meet strict criteria for T-QRS-D. That said — we KNOW this is a hugh anterior STEMI from acute LAD occlusion — and qualitatively at least, the SHAPE of the distorted terminal portion of the QRS in leads V2, V3 and V4 is so clearly abnormal and obviously consistent with acute OMI even though we cannot use lead V4 in the definition of T-QRS-D (because confirming data in V4 is lacking) — and as you say, strict definition of T-QRS-D is not met in V2 because of that small J-notch. Otherwise — I agree that there is P wave notching in a number of leads (especially leads V3-thru-V6). That said, overall P wave amplitude is low, and morphology for either LAA or RAA (left or right atrial abnormality) is lacking. Most likely, this P wave notching reflects some intra-atrial conduction delay (whether this is acute and related to the MI, or longstanding). Given the overall low P wave amplitude, I chose not to mention this. Clinically, I don’t think it important in this case. For more on RAA/LAA/Intra-Atrial Conduction Defects — Please check out this LINK — http://ecg-interpretation.blogspot.com/2013/09/ecg-interpretation-review-75-chamber.html — :) ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44370161027916892492019-12-15T19:33:28.943-06:002019-12-15T19:33:28.943-06:00Great case, very good!!!In your remarkable explana...Great case, very good!!!In your remarkable explanation you have writed that there is marked T-QRS-D in leads V2 and V3, but i am confusing because i have seen a small J-wave in V2. In other words, are there T-QRS-D in V2 AND V3 or only in V3? Additionally,i realized that there is the presence of broad, notched (bifid) P waves in some leads, can i concern with this findings regarding P wave?O Poder da Eletrocardiografiahttps://www.blogger.com/profile/11143192155299060176noreply@blogger.com