tag:blogger.com,1999:blog-549949223388475481.post9095756262576947263..comments2024-03-19T02:33:29.499-05:00Comments on Dr. Smith's ECG Blog: Do patients with LBBB and STEMI, when reperfused, develop T-wave inversion (reperfusion T-waves)?Unknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-87446381682123015072017-01-24T10:06:29.933-06:002017-01-24T10:06:29.933-06:00Glad you liked it, Mario!
SteveGlad you liked it, Mario!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-24109194681655957222017-01-24T09:27:54.114-06:002017-01-24T09:27:54.114-06:00Very instructive case demonstating that LBBB does ...Very instructive case demonstating that LBBB does not prevent us to diagnose not only STEMI but now even Wellens' pattern. Many thanks for presenting this case!Mario Parrinellohttps://www.blogger.com/profile/07136945770330333718noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68540117052700089722017-01-22T06:24:26.071-06:002017-01-22T06:24:26.071-06:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-50327448435713842942017-01-22T06:24:11.898-06:002017-01-22T06:24:11.898-06:00Sam,
As above, circumflex!
SteveSam,<br />As above, circumflex!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12227793429932104962017-01-20T20:55:44.135-06:002017-01-20T20:55:44.135-06:00Great Case & ECGs. I would also say that in ad...Great Case & ECGs. I would also say that in addition to the disproportionate ST-Elevation in the inferior and lateral leads, even more salient are the classic hyperacute T-waves (the disparity after reperfusion is vast). Also interesting, in addition to the Posterior Reperfusion T-waves (although not meeting "Sgarbossa threshold" of 1mm) there appears to be "relative ST-depression" in V2 + V3 when the artery is occluded. Some really interesting findings. Incidentally, was this circumflex in a left-dominant heart? <br />Thanks for sharing! <br />-SGSam Ghalihttps://twitter.com/EM_RESUSnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53325172160140115522017-01-20T16:04:38.149-06:002017-01-20T16:04:38.149-06:00Regardless of whether one calls the changes we see...Regardless of whether one calls the changes we see here (in serial tracings on this case submitted by Wendell Meyers) as “Wellens Syndrome” in another coronary distribution — or simply evolutionary changes diagnostic of coronary occlusion followed by spontaneous reperfusion — the points to emphasize are: i) The sensitivity of the ECG for picking up acute evolving ST-T wave changes is reduced when there is a preexisting conduction defect; ii) That said, despite QRS widening on the baseline tracing (from LBBB or other conduction defect) — one CAN sometimes identify clear evidence of acute coronary occlusion in progress on the initial ECG (as was evident on the initial = Time Zero ECG in this case); iii) Serial ECG assessment can sometimes prove invaluable for removing any shadow of doubt that despite baseline QRS widening, acute STEMI is in progress. In this case, despite baseline LBBB — the ST-T waves we see in lead V6 on the initial tracing in the context of new chest pain are clearly abnormal — because with typical LBBB or RBBB, ST-T waves should normally be OPPOSITE to the last QRS deflection at least in leads I, V1 and V6. They are not in lead V6 here. And, in light of the definitely abnormal upright T wave in lead V6 on this initial ECG — the upright T wave in neighboring lead V5 is clearly taller-than-expected and abnormal. In a patient with new chest pain, regardless of the minimal amount of ST deviation in these leads — these ECG findings are diagnostic. And, in the 2nd ECG — lead-by-lead serial comparison should remove any doubts that might have remained, because of subtle-but-real increased amount of ST elevation now in leads II, III, aVF; V5 and V6 — in association with more reciprocal ST depression now in lead aVL. THANKS for presenting this GREAT case with important messages on assessing the ECG in a patient with new chest pain and baseline QRS widening.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com