tag:blogger.com,1999:blog-3364570834099131201.post5703699445450135905..comments2024-03-23T08:57:50.965-04:00Comments on ECG Interpretation: ECG Interpretation Review #53 (Peaked T - Hyperacute - DeWinter - Wellens - aVR)ECG Interpretationhttp://www.blogger.com/profile/02309020028961384995noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-3364570834099131201.post-37754926998532308672016-10-24T13:59:21.238-04:002016-10-24T13:59:21.238-04:00Thanks for your comment. Although in V2, the shape...Thanks for your comment. Although in V2, the shape of the ST segment per se might seem consistent with a repolarization variant — there are MANY clues in this case that tell us this is not a benign pattern. These include — the history (chest pain) — dysproportionately tall ST-T waves in V2,V3 (compared to the tiny r wave in these leads) — frank ST elevation elsewhere (ie, aVL) — frank reciprocal ST depression elsewhere. The diagnosis of early repolarization should always be one of exclusion. And yes, given that the ST-T wave pattern we see here in the chest leads reflects DeWinter T waves — this DOES localize the lesion to the proximal LAD.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-8646054995923920152016-10-24T08:48:48.639-04:002016-10-24T08:48:48.639-04:00Dr. Grauer, it seems that the usually benign upslo...Dr. Grauer, it seems that the usually benign upsloping STJ depression becomes malignant in the context of hyperacute T (=DeWinter pattern). If it happens to happen in other lead groups (does it?), would it be localizing like STE (is it a localizing sign?)?<br /><br />Thank you!<br /><br />IonUnknownhttps://www.blogger.com/profile/01969184662531376668noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-47417082845498512232015-09-01T05:58:36.713-04:002015-09-01T05:58:36.713-04:00The best "tool" for accurate identificat...The best "tool" for accurate identification of "hyperacute" ST-T wave changes is YOUR EYES! This comes with experience of becoming totally comfortable with what is "normal" vs abnormal. Rather than focus on any one lead to see if the ST-T wave looks to be "hyperacute" — all 12 leads should be looked at (ie, support that what looks to be a hyperacute T wave may be forthcoming from the finding of reciprocal ST depression elsewhere on the tracing). The best way I can describe "hyperacute" T wave changes is that the T wave just does not look proportionate/normal given the QRS complex in that lead — that is, the T wave is taller or fatter-than-expected, or that it looks like it is "trying" to elevate, but hasn't yet done so, or has only minimally elevated ... (look at leads II,V5,V6 in my ECG Blog #80 — http://ecg-interpretation.blogspot.com/2013/12/ecg-interpretation-review-80-acute.html ).ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-58495367966045584192015-09-01T01:13:45.524-04:002015-09-01T01:13:45.524-04:00Is there any reliable ECG criteria for accurate ...Is there any reliable ECG criteria for accurate identification of hyperacute T wave ? <br />Anonymoushttps://www.blogger.com/profile/06475696764299734880noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-30176615115039365542013-11-18T18:23:50.699-05:002013-11-18T18:23:50.699-05:00Salut Lot Ben! Good question you ask. Leads III an...Salut Lot Ben! Good question you ask. Leads III and aVL are almost directly opposite each other - so they often show a mirror-image picture of ST elevation in one lead and ST depression in the other. If you FLIP OVER (in your mind's eye) the picture of ST elevation we see in lead III - the "mirror-image" of this would be the same shape for the ST segment in lead aVL - so I do think there IS inferior reciprocal ST depression. That said - given the cylindrical shape of the LV - any lead area can in theory be opposite any other lead area. Thus you can see "reciprocal changes" in any other lead area away from the acute of acute ongoing infarction.<br /><br />ST elevation in Lead aVL is often seen with anterior MI. The picture here I think is very typical for DeWinter T waves given the dramatically tall T wave (esp in lead V3 given small height of the QRS) with J-point ST depression in V4-V6 before forming the tall T waves - so to me, highly suggestive of a proximal LAD lesion. You may want to review the 3 links I give above under References for more on these entities. THANKS again for your comment!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-3364570834099131201.post-46230168140447186042013-11-18T07:23:16.988-05:002013-11-18T07:23:16.988-05:00hello doctor
is the ST depression in inferior lead...hello doctor<br />is the ST depression in inferior leads due to reciprocal changes in anterior leads or is it reciprocal of the slight st elevation in AVL ? even if in AVL the STE is not egregious its existance may also give another proof of involvement of the proximal LAD .<br />the other clue is the amount of qrs amplitude in V3 wich is very "tiny" if we compare it to the Tall T wave, isn't that highly suggestive that some ischemia is going on ?<br />merci beaucoup <br /><br />votre plus grand fan d'Algérie.bornDzhttps://www.blogger.com/profile/14881573967112036335noreply@blogger.com