tag:blogger.com,1999:blog-3364570834099131201.post3474041309855508092..comments2024-03-23T08:57:50.965-04:00Comments on ECG Interpretation: ECG Interpretation Review - #6 (Chest Pain, Subtle ECG Changes)ECG Interpretationhttp://www.blogger.com/profile/02309020028961384995noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-3364570834099131201.post-80974135395911042772022-12-17T21:25:19.441-05:002022-12-17T21:25:19.441-05:00The reason the QRS in lead I is so tiny — is that ...The reason the QRS in lead I is so tiny — is that the frontal plane axis is approximately +90 degrees. Note how much taller leads II and III are than lead I. So the main "vector" of electrical activity is between leads II and III (and oriented at approximately +90 degrees). Since lead I is the limb lead that is furthest away from this, it is tiny. ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-589995353917898812022-12-14T02:22:57.239-05:002022-12-14T02:22:57.239-05:00Why lead I look lik this small complex?Why lead I look lik this small complex?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-83420964496364683752020-08-08T19:43:11.315-04:002020-08-08T19:43:11.315-04:00Leo Schamroth many years suggested the finding of ...Leo Schamroth many years suggested the finding of a null vector (or almost null vector) for the QRS and ST-T wave in lead I (ie, TINY amplitude in lead I) — was a strong suggestive hint of significant pulmonary disease. This is not a common finding — but I completely agree that it CAN be quite helpful when seen. That said — this finding can be seen in slender individuals or those with a “vertical heart” not necessarily associated with severe pulmonary disease. I really don’t see other signs of RVH on this tracing (no RAA, no RV “strain”, no persistent deep S waves in lateral chest leads; and transition IS between V3-to-V4, so really not "poor R wave progression") — so while I’d consider the possibility of pulmonary disease — I probably would not call it in this patient given the above — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-20116421237006096682020-07-11T01:45:23.191-04:002020-07-11T01:45:23.191-04:00Hi Dr. Grauer, great blog. I am just wondering thi...Hi Dr. Grauer, great blog. I am just wondering this ecg is suggestive of an emphysema in this man - of course after ruling out ACS. Small qrs complex in lead 1, negative qrs in AvL, poor r wave progression all could point to emphysema? pshttps://www.blogger.com/profile/17817624465143825655noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-85503707388724046562017-10-03T17:48:40.128-04:002017-10-03T17:48:40.128-04:00There are definite small r waves present in V1,2,3...There are definite small r waves present in V1,2,3 — and there is normal R wave height in lead V4. Yes, it is true that one may lose r wave amplitude with anterior infarction — and it is good to note that the r waves are small here — but this finding in the absence of clear acute changes in not specific ... A more common cause of small R waves is lead misplacement. Hard to know what is going on here because this patient is having chest pain and the ST-T segments while not suggesting acute change are also not completely normal ...ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-83739440730931887052017-10-03T11:06:58.488-04:002017-10-03T11:06:58.488-04:00Although the RS transition is normal but from v1 t...Although the RS transition is normal but from v1 to v3 the R wave height is not quite what we would expect in a 45yr old male... Can this be a benign finding in otherwise asymptomatic pts?<br />Can this be a sign of anterior wall involvement in this case with chest pain 45yr old male? MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-79777700883164978222017-08-06T05:36:40.688-04:002017-08-06T05:36:40.688-04:00@ MG — Thank you for your comment! The difficulty ...@ MG — Thank you for your comment! The difficulty in assessing the ST-T wave in lead I is how tiny the overall complex in this lead is. I don't think there is enough to call the picture we see in lead I as "hyperacute changes" — but the Bottom Line (as I emphasize above) is that we cannot know this for certain from this single ECG, and that regardless of how one interpret's ST-T wave changes in lead I, that close follow-up is indicated in this patient with new symptoms. This would include an Echo (which can be diagnostic if a wall motion abnormality is seen during symptoms), follow-up tracings, and troponins (since this patient is presenting to the ED with this tracing). Unfortunately — I do not have follow-up on this case.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-4651504328648866602017-08-06T05:19:16.880-04:002017-08-06T05:19:16.880-04:00Hello sir...
What about Lead 1... The T wave looks...Hello sir...<br />What about Lead 1... The T wave looks hyperacute T wave when compared to its QRS...<br />Was there any follow up on this case???<br />Thank youMGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-58155786134527561112014-08-01T00:18:10.917-04:002014-08-01T00:18:10.917-04:00Good question Andrew. There are many potential cau...Good question Andrew. There are many potential causes of ST-T wave flattening. To me - the principal significance of recognizing that ST-T waves in leads like II,III,aVF and V6 in this tracing are distinctly straight with abrupt transition from ST segment-to-T wave - is that it tells me the ST segments are not "normal". Coronary disease (ischemia) may clearly cause such flattening. Other factors (drugs, electrolyte disturbance, hyperventilation, etc.) may also cause such flattening - however the ST-T wave straightening that we see here occurs in the context of a previously healthy 45 yo who presents with new-onset chest discomfort. In this context - ischemia/coronary disease move to the forefront of conditions that should be excluded.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-17259299666986771982014-07-31T22:45:31.957-04:002014-07-31T22:45:31.957-04:00What is the significance of ST segment flattening?...What is the significance of ST segment flattening? I understand it must be clinically coordinated, but theoretically what could this imply?Anonymoushttps://www.blogger.com/profile/06228127529170350748noreply@blogger.com