tag:blogger.com,1999:blog-549949223388475481.post7428928976544773009..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: 10 Cases of Inferior Hyperacute T-wavesUnknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-4489493571150142672016-05-02T08:29:00.108-05:002016-05-02T08:29:00.108-05:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43594538017010479852016-05-02T00:00:54.003-05:002016-05-02T00:00:54.003-05:00I 've seen a patient with an ECG similar to ca...I 've seen a patient with an ECG similar to case 8 <br /><br />The patient was about to be given fibrinolytic<br />I remembered your case <br />It was so helpful <br /><br />Thanks ;-)Anonymoushttps://www.blogger.com/profile/08488975105375814621noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29819628393608024652016-05-01T14:01:26.718-05:002016-05-01T14:01:26.718-05:00THANKS to Dr. Steve Smith for providing us with 10...THANKS to Dr. Steve Smith for providing us with 10 more tracings for teaching the concept of recognizing hyperacute ST-T wave changes in inferior leads (to complement his recent excellent post showing 10 examples of anterior hyperacute T waves).<br /><br />Confidence in recognizing this KEY concept becomes easier by review of readily available multiple examples — which can easily be accomplished on this (and Dr. Smith’s other) Blog by clicking on 1 tracing (best to view on a computer rather than the small screen of a smart phone) — and then simply advancing the arrow on your keyboard to rapidly go through the tracings. Embed in your mind which specific features are the definitive clues in each case for a patient with worrisome chest pain that should suggest an acute stemi is evolving. Dr. Smith provides links with detailed case studies and answers. Some of these tracings are easier than others to recognize — especially when additional clues are provided in the chest leads. But virtually ALL have the essential “pattern recognition clue” that one or more inferior T waves just “don’t fit” (ie, they are taller, wider-at-the-base, and/or “fatter-at-the-peak” than they should be given the accompanying QRS complex in the same lead) — WITH unmistakeable mirror-image features seen in leads III and aVL.<br /><br />For example, if there is any doubt that the T wave in lead III of ECG #1 is hyperacute — it shouldn’t take more than a glance at lead aVL to recognize a perfect “mirror image” of what we see for the ST-T wave in lead III. Confirmation that this is real comes from similar reciprocal change to aVL in lead I. Extra clues are obviously present in ECG #1 in the chest leads (ie, leads V3,V5,V6).<br /><br />#ECG #2 is more subtle — but the T wave peak is “fatter-than-it-should-be” in each inferior lead with reciprocal change in lead aVL. As an example of how carefully one needs to look — the straight ST segment prior to a more-pointed-than-it-should-be T wave in V2 supports posterior involvement in ECG #2.<br /><br />A similar “theme” is seen in ECGs #3,4,5,6 — and in the last few tracings shown here.<br /><br />ECG #7 is worth special mention. The abnormality in the limb leads did not jump out at me until I clicked on this tracing to magnify it. <br />Although admittedly subtle — in the context of a patient with new chest pain — the T wave in lead III looks a bit fatter-than-it-should-be at its peak — AND — there is subtle suggestion of reciprocal change in lead aVL. In this context — the T in lead aVF is also a bit fatter-than-it-should-be — and in the chest leads there is subtle-but-real ST straightening in leads V2,V3. None of this is definitive — but it should clearly increase one’s suspicion and place the onus of immediate close follow-up on the provider to determine if the above are subtle signs of ongoing infero-postero stemi.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com