tag:blogger.com,1999:blog-549949223388475481.post8710923646054304177..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Male in his 40's with chest pain. Unknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-44395528258054755932015-11-26T10:57:06.108-06:002015-11-26T10:57:06.108-06:00My pleasure!My pleasure!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7299999473908230532015-11-26T10:56:03.899-06:002015-11-26T10:56:03.899-06:00Thanks as always. Thanks as always. Joe Bhttps://www.blogger.com/profile/12846267159366742350noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53650637362581502322015-11-26T10:53:33.555-06:002015-11-26T10:53:33.555-06:00Joe,
It requires recognizing that the EKG is ische...Joe,<br />It requires recognizing that the EKG is ischemic. It is unequivocally ischemic if you have the expertise to interpret it: first, it meets the formula criteria, then it resolves. This change can only happen if the findings really are ischemic findings.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-20369596228536512632015-11-25T09:58:14.767-06:002015-11-25T09:58:14.767-06:00Hi Dr. Smith,
In relation to the first EKG and ne...Hi Dr. Smith, <br />In relation to the first EKG and negative troponins, how do you differentiate who can benefit from cath in negative troponin patients as there can be some harm chasing ekgs without evidence of acute MI? In other words, if this was not stemi but instead some mild depressions or mild ischemic t wave inversions and they ruled out for MI (negative trops, maybe normal echo), do you in your practice still push for cath? Thanks, always appreciate your take. Joe Bhttps://www.blogger.com/profile/12846267159366742350noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60651715605485560902013-01-30T03:54:57.513-06:002013-01-30T03:54:57.513-06:00Thanks. . In fact pci was not available at that ti...Thanks. . In fact pci was not available at that time.. treated medically as ACS.. i will follow if he is going to do pci latermaateeqhttps://www.blogger.com/profile/10063793989441938455noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60694018848896298292013-01-29T09:03:10.958-06:002013-01-29T09:03:10.958-06:00Mateeq, I looked at the ECG and it does not look l...Mateeq, I looked at the ECG and it does not look like an LAD occlusion. Was it? And was it occluded at the time of the ECG? That is hard to determine, but if the patient had chest pain at the time of the ECG and the angiographic culprit was a thrombotic LAD lesion (whether open or closed), then likely yes. But this one would fool me or the equation if that is so. I very much doubt that the LAD was occluded at the time this ECG was recorded.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27770799454476304172013-01-29T03:46:03.752-06:002013-01-29T03:46:03.752-06:00Hi Dr.Smith.. I tried to apply the equation on 24y...Hi Dr.Smith.. I tried to apply the equation on 24year old male who came with atypical chest pain for two days. Troponin 33.9 CK 3300 with CKMB 300 . trop peaked 39 then dropped to 16 on third day.. ECHO was normal. have a look on ECG file PDF <br />https://www.dropbox.com/s/0j9h4iikb1joadt/ECG1.pdf<br /><br />thanksmaateeqhttps://www.blogger.com/profile/10063793989441938455noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17727638888122562342013-01-20T11:04:14.484-06:002013-01-20T11:04:14.484-06:00They look pathological. Probably old inferior MI....They look pathological. Probably old inferior MI.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3404261210829058362013-01-19T21:13:30.713-06:002013-01-19T21:13:30.713-06:00Congrats..great case..8 wonder if those Inferior l...Congrats..great case..8 wonder if those Inferior leads q waves are pathological onesHector Munozhttps://www.blogger.com/profile/10157498764409620840noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46104020058617162532013-01-17T06:42:33.633-06:002013-01-17T06:42:33.633-06:00Pericarditis usually has an ST axis of around 60 d...Pericarditis usually has an ST axis of around 60 degrees, resulting in STE in II (as you say) and V5 mostly. Though it happens, maximal STE in V2 and V3 is unusual. Most unusual though is even a hint of ST depression anywhere, and one might imagine that there is reciprocal ST depression in lead III (reciprocal to aVL). Could a patient with pericarditis have an ECG like this? Probably. But there would not be resolution of symptoms (and ECG findings!) so quickly. This is only typical of reperfusing MI. <br /><br />Finally, pericarditis is far less common than MI, and even less common than previously thought. A recent study using CT coronary angiography showed that half of patients with transient ST elevation and normal coronaries (who might have been diagnosed with pericarditis) have extraluminal plaque in the territory with ST elevation that accounts for the findings.<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80294082865338841302013-01-16T16:17:27.925-06:002013-01-16T16:17:27.925-06:00Dear Dr Smith,
What made you immediately exclude (...Dear Dr Smith,<br />What made you immediately exclude (or at least omit from the discussion) the diagnosis of pericarditis? Diffuse concave st elevations, no reciprocal changes (aside from avr), STE II>III, and perhaps even subtle PR depressions .<br />thank you for this invaluable resource!SHhttps://www.blogger.com/profile/14181147260079162812noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-66353570860637255702013-01-16T14:14:03.815-06:002013-01-16T14:14:03.815-06:00I'm not sure it is either widely known or acce...I'm not sure it is either widely known or accepted. It was only recently published.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-24670815234713275002013-01-16T13:51:21.203-06:002013-01-16T13:51:21.203-06:00If this formula was accepted widely, what would be...If this formula was accepted widely, what would be done differently? maateeqhttps://www.blogger.com/profile/10063793989441938455noreply@blogger.com