tag:blogger.com,1999:blog-549949223388475481.post626470370685818751..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A 50-something male with DyspneaUnknownnoreply@blogger.comBlogger17125tag:blogger.com,1999:blog-549949223388475481.post-29506348965971556872015-03-25T10:27:58.155-05:002015-03-25T10:27:58.155-05:00Jyoti,
Plenty of posterior MIs have this kind of S...Jyoti,<br />Plenty of posterior MIs have this kind of ST depression.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27070062408605739332015-03-25T10:15:52.192-05:002015-03-25T10:15:52.192-05:00STD in Rt Precordial leads are asymmetrical- unlik...STD in Rt Precordial leads are asymmetrical- unlikely MIEqubal , Family Physicianhttps://www.blogger.com/profile/15668924554489069795noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-31833722417377838942015-03-12T23:22:39.580-05:002015-03-12T23:22:39.580-05:00Thanks doc I think I understand the how the distan...Thanks doc I think I understand the how the distance will affect the voltage and why a lower criteria is used for posterior elevation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-50601759770435229392015-03-12T13:09:50.783-05:002015-03-12T13:09:50.783-05:00Whether precordial ST depression shows on posterio...Whether precordial ST depression shows on posterior leads depends on how well the voltage conducts from the heart to the posterior chest, which is a long distance and through the air of the lungs. This depends on 1) whether the ST depression "force" is coming from the subendocardium of the anterior wall, which is close to the overlying leads or from the epicardium of the posterior wall (Since it is due to RVH, it is coming from the subendocardium of the very anterior and hypertrophied RV), in which case it is close to the recording leads and likely to show high voltage ST shift, or if the force is coming from the subepicardium of the posterior wall, as in a posterior STEMI, in which case any anterior ST depression is more likely to show on posterior leads. Any ST depression in the anterior leads will have reciprocal ST elevation in posterior leads; the question is a matter of voltage -- how far does it have to go and how much air is between them. This is why ST elevation on posterior leads had a "criterion" of only 0.5 mm - the voltage doesn't show well. It is also why many posterior STEMI show well on the anterior leads but NOT on posterior leads. Overall, though, posterior leads are more sensitive at 0.5 mm. Complicated, no?Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54741985330597589292015-03-11T23:39:55.102-05:002015-03-11T23:39:55.102-05:00Dr Smith if we had run V7 V8 V9 would we still see...Dr Smith if we had run V7 V8 V9 would we still see ST elevation leading to a false positive for posterior MI?<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-71969561328976332602015-03-07T12:55:04.740-06:002015-03-07T12:55:04.740-06:00Thank you Thank you Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61515649040840885322015-03-07T09:49:18.819-06:002015-03-07T09:49:18.819-06:00That is just not a reliable enough finding.That is just not a reliable enough finding.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7979057347326995782015-03-07T09:48:42.720-06:002015-03-07T09:48:42.720-06:00That is just not a reliable finding.That is just not a reliable finding.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19560127314468556382015-03-07T06:47:00.935-06:002015-03-07T06:47:00.935-06:00If it is airway desease,why the P-waves are normal...If it is airway desease,why the P-waves are normal?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85340020264535418182015-03-06T15:59:31.283-06:002015-03-06T15:59:31.283-06:00Nice ECG thank you!But the P-waves look normal,if ...Nice ECG thank you!But the P-waves look normal,if the pulmonary pressure is so high 72mmHg, P-wave should be pathologic.Isn't it?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74514239730427237202015-03-04T14:59:40.823-06:002015-03-04T14:59:40.823-06:00there is slightly more area under the curve of the...there is slightly more area under the curve of the S-wave than the R-wave (in lead I). Just barely > 90 degrees, therefore RAD.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88445531388500710692015-03-04T14:50:42.508-06:002015-03-04T14:50:42.508-06:00Is this vertical axis or RAD? Is this vertical axis or RAD? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74331018374006867732015-03-04T05:44:47.353-06:002015-03-04T05:44:47.353-06:00nice ecg. thanks..nice ecg. thanks..Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19410566008808948842015-03-03T15:31:36.952-06:002015-03-03T15:31:36.952-06:00see answer abovesee answer aboveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-79981550662552218312015-03-03T05:45:57.791-06:002015-03-03T05:45:57.791-06:00Jason, the workup for PE was done and was negative...Jason, the workup for PE was done and was negative. Etiology was airway disease. McGinn (S1Q3T3) is a very soft sign of PE. In a large group of dyspneic patients worked up for PE, those without PE had a 3% incidence of S1Q3T3 and those with PE had an incidence of 8%, for very low positive and negative predictive values. Also, PE does not give large R-waves in right precordial leads.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82850408739629383272015-03-02T18:35:49.393-06:002015-03-02T18:35:49.393-06:00There is also a S1Q3T3 as a hint to PHT in this EC...There is also a S1Q3T3 as a hint to PHT in this ECG.eli alkalayhttps://www.blogger.com/profile/06950813041027542977noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43025112779000637072015-03-02T17:27:34.006-06:002015-03-02T17:27:34.006-06:00Nice post Steve, just curious about the D-dimmer l...Nice post Steve, just curious about the D-dimmer lab results? McGinn-White sign also seen on this ECG. Thanks<br /><br />This ECG certainly mimics posterior wall infarction at the first glance. Jason Lee Winterhttps://www.blogger.com/profile/15234259550852349847noreply@blogger.com