tag:blogger.com,1999:blog-3364570834099131201.post1106830517837378638..comments2024-03-23T08:57:50.965-04:00Comments on ECG Interpretation: ECG Interpretation Review #48 (Chest Pain - STEMI - 1st Degree - 2nd Degree AV Block - Infero-lateral - 2-to-1 - Wraparound)ECG Interpretationhttp://www.blogger.com/profile/02309020028961384995noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-3364570834099131201.post-34462206340733489302015-12-15T05:52:08.423-05:002015-12-15T05:52:08.423-05:00So SORRY for my delay in responding! You are absol...So SORRY for my delay in responding! You are absolutely correct. Excellent observation on your part. The RED arrows in simultaneously recorded lead II do reflect the correct spatial relationship.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-6748159533606539662015-09-03T06:36:03.335-04:002015-09-03T06:36:03.335-04:00Hello Mostafa. The answers to many of your questio...Hello Mostafa. The answers to many of your questions are, "maybe", "hard to say" and "it depends" ... A very proximal "wraparound" may be a lethal lesion (ie, = proximal LAD + inferior infarction equivalent ... ). The point that I believe you are realizing with your thoughtful questions is that what one sees on the ECG is the "net effect" of everything that is going on (ie, there may at times be things going on that partially or more than that "cancel" each other out). Much of the time — the clinical scenario + assessment of the entire "Gestalt" of the 12-lead will lead to the correct diagnosis (facilitated IF there are also prior tracings to compare to) — but your questions are not things that have any fixed "rules" that I know of ...ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-69916262013751773492015-09-02T23:01:09.172-04:002015-09-02T23:01:09.172-04:00If proximal wraparound occlusion , simultaneous is...If proximal wraparound occlusion , simultaneous ischemia of high lateral wall and inferior wall cancel each other , as lead III is opposing forces to aVL .<br />which lead will be elevated more in this situation? aVL or lead III, Can they be isoelectric in this situation.<br />What about other leads I,II,aVF ?<br />How differentiate between Proximal Wraparound LAD Vs Mid ?Anonymoushttps://www.blogger.com/profile/06475696764299734880noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-1913819800455358872015-08-05T03:46:14.614-04:002015-08-05T03:46:14.614-04:00In the figure 2, in lead I, the first and the thir...In the figure 2, in lead I, the first and the third blue arrows, im my opinion should be put on the first hump of T wave.<br />The interval between P waves, appears, im my opinion slightly different.<br />ThanksStilichohttps://www.blogger.com/profile/13908484620668565360noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-10354509207098486292012-07-19T17:19:20.366-04:002012-07-19T17:19:20.366-04:00I was off today, so i couldn't get a hold of t...I was off today, so i couldn't get a hold of the strips, but i'll see if they are still available at work tomorrow, and i'll email them if they are available. Thanks for your response.James Deanhttps://www.blogger.com/profile/01767660575886231531noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-77817545772446715842012-07-18T23:42:03.238-04:002012-07-18T23:42:03.238-04:00Hi James. I can't think of an explanation for ...Hi James. I can't think of an explanation for what you describe with dramatically changing PR intervals - unless there is a changing P-to-QRS relationship ... I'm afraid I would need to see the actual rhythm strips in order to be able to comment more on this .... IF you have them - you could send to ekgpress@mac.com - KenECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-45178843311566781432012-07-18T22:02:22.397-04:002012-07-18T22:02:22.397-04:00Hello Doc, sorry to bother, but i got a question r...Hello Doc, sorry to bother, but i got a question regarding some ecg rhythms i saw today for one individual. This person had a first degree av block, with PR interval of about 0.24, when he woke up this morning his PR interval had jumped to 0.40, and stayed thereabouts for most of the morning, By the afternoon his PR interval had started shortening, at the end of the day his pr interval was 0.18 i.e it could no longer be plausibly called a 1st degree block. I was wondering if there was an interpretation for these sort of ecg changes, especially if it happens in a cyclical manner. Is this some sort of AV dissociation that is not written about in books or what do you think is going on here? <br /><br />Thanks in advanceJames Deanhttps://www.blogger.com/profile/01767660575886231531noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-5854075509173161102012-07-10T22:44:54.700-04:002012-07-10T22:44:54.700-04:00Hi Mario. I'm working on a web page that will ...Hi Mario. I'm working on a web page that will illustrate this - but haven't yet finished with the picture... But think of the LAD (left anterior descending) coronary artery as supplying the anterior wall as it flows down the front (anterior wall) of the heart. In some patients, that vessel is longer - such that it not only reaches the very tip (apex) of the heart - but wraps around underneath to also supply a portion of the inferior wall. Thus, with a "wraparound LAD" - occlusion may lead to ST elevation not only over anterior leads (V2,V3,V4) - but also over the inferior leads (II,III,aVF).ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-62768965196745563752012-07-10T21:54:16.506-04:002012-07-10T21:54:16.506-04:00I love it thanks, The Wraparound can you produce a...I love it thanks, The Wraparound can you produce a PIC? Or did i over look? If in-front of my face, i over look. I always do.<br /><br />GOD BLESS,<br /><br />My friend.jesuscame2mehttps://www.blogger.com/profile/12634964727651015014noreply@blogger.com