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See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.
STE limited to aVR is due to diffuse subendocardial ischemia, but what of STE in both aVR and V1? Here is an article I wrote: Updates on the ECG in ACS. The additional ST Elevation in V1 is not usually seen with diffuse subendocardial ischemia, and suggests that something else, like STEMI from LAD occlusion, could be present.
The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." Here is another classic article. Comment: most T-wave inversion is nonspecific, but not these ones!
Arterial pulse tapping artifact [link] This online article references the article below by Emre Aslanger, a great guy who occasionally corresponds with me about ECGs. Electromechanical association: a subtle electrocardiogram artifact. Figure-3: Page 475 from the Rowlands and Moore article that I reference above.
This was just published in JAMA Internal Medicine: The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves It reminded me that many believe, due to the assertions in the original de Winter's article, that de Winter's waves are stable.
Background: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard markers of ischemia and because ECG confounders may prevent their application. Normal QRS-T angle From this article: Ziegler R and Bloomfield DK.
The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU. The ECG, as it turns out, is the best predictor , better the TMP grade because TMP measures microvascular patency, and the ECG measures cellular viability ( see this full text article and this abstract ).
Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.
Long-term Follow-up of Patients with Brugada Syndrome from a Tertiary Referral Center in Iran Abstract Background Brugada syndrome (BrS) is characterized by ST-segment elevation in the right precordial leads, which is not explained by ischemia, electrolyte disturbances, or obvious structural heart disease. 01), longer PR interval ( p =.03),
The article is edited by Smith. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. This was submitted by Alexandra Schick. Dr. Schick is a PGY3 at the Brown Emergency Medicine Residency in Rhode Island. I remember Allie well from her days in the Research volunteer program at Hennepin.
Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm. Evidence of acute ischemia (may be subtle) vii. Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Left BBB vi.
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