ECG Guru - Instructor Resources - T Wave Inversion https://www.ecgguru.com/ecg/t-wave-inversion en Giant T Wave Inversions https://www.ecgguru.com/ecg/giant-t-wave-inversions-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/giant-t-wave-inversions-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/060403%20Giant%20T%20wave%20inversions%20Edit%20for%20Guru_1.jpg" width="1648" height="929" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG was obtained from a man in his 70’s.&nbsp; We have no other clinical information.&nbsp; It is interesting for several reasons.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>Giant T wave inversions</strong> &nbsp; &nbsp;&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">The most obvious abnormalities we see on first inspection are the deeply inverted T waves in Leads V3 through V6. The T wave in V3 is biphasic.&nbsp;There are also T wave inversions in all of the limb leads except aVR.&nbsp; The precordial T wave inversions are called “giant T wave inversions” because they are 10 mm or more in depth.&nbsp; There are many causes of giant T wave inversions, including, but not limited to: myocardial ischemia, coronary artery disease and reperfusion, pulmonary edema, massive pulmonary embolism, subarachnoid hemorrhage, apical hypertrophy, post-tachycardia syndrome, and post-pacing syndrome.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>What else?</strong> &nbsp; &nbsp; There are no Q waves or ST elevations.&nbsp; The ST segments are not entirely normal in shape, being flattened in most lead.&nbsp; The frontal plane axis is left.&nbsp; Even though the ECG <em>almost </em>meets <a title="LVH criteria" href="http://ecg.utah.edu/lesson/8"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">criteria for left ventricular hypertrophy</span></a>, by exclusion we would call this anterior fascicular block (left anterior hemiblock).&nbsp; &nbsp;Obviously, it would help greatly if we had some history and clinical information to accompany this ECG.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">If the patient has complained of chest pain which has now resolved, we would be concerned about reperfusion T waves, or <span style="color: #0070c0;"><a title="Wellens Syndrome litfl" href="http://lifeinthefastlane.com/ecg-library/wellens-syndrome/">Wellen’s Syndrome</a>.&nbsp; </span>Usually, the T wave changes of Wellen’s Syndrome are prominent in V2 and V3, but we would consider the possibility of a not-so-correct electrode placement.&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">The reperfusion T wave inversions of Wellen’s Syndrome are a dire warning:</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">the left coronary artery has significant disease, and is intermittently occluding.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; Wellen's Syndrome means that a</span><span style="font-size: 13.008px; line-height: 1.538em;">cute anterior wall M.I. is threatening.</span></p><p class="MsoNormal"><strong>The rhythm is also interesting</strong>.&nbsp; From beat 4 until beat 10, the rhythm is fairly regular, but with slight variations in rate.&nbsp; Beats 7 and 11 may have slightly different P waves, but only to those who scrutinize very closely.&nbsp; Beats 1, 2, and 3 are irregular and have inverted P waves in the inferior leads, a sign that they are being conducted in a retrograde direction.&nbsp; The PR intervals seem to be shortening in beats 2 and 3, but there is not enough strip at that end to know for sure what is happening.&nbsp; Then, at the end of the strip, beat 12 arrives so early that we can’t evaluate the P wave, as it is buried in the T wave of beat 11.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>For comparison &nbsp; &nbsp;&nbsp;</strong>There is <a title="Deep symmetrical T wave inversions" href="http://ecgguru.com/ecg/deep-symmetrical-t-wave-inversions"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">another ECG </span></a>with giant T wave inversion on our site that you might like to look at for comparison purposes. &nbsp;Dr. Ken Grauer also has a nice <a title="Dr. Grauer T wave inversions" href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html?m=1"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">example</span></a>, with thorough discussion, on his website. I will look forward to any comments from our experts and our readers.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Giant T Wave Inversions 1/5</option><option value="40">Give Giant T Wave Inversions 2/5</option><option value="60">Give Giant T Wave Inversions 3/5</option><option value="80">Give Giant T Wave Inversions 4/5</option><option value="100" selected="selected">Give Giant T Wave Inversions 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.2</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-45mUZuILG0fqQqeitiPO9G8NWtfrIERtaqXwzHfbc5w" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fgiant-t-wave-inversions-0&amp;title=%20Giant%20T%20Wave%20Inversions%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Tue, 24 May 2016 21:17:47 +0000 Dawn 699 at https://www.ecgguru.com https://www.ecgguru.com/ecg/giant-t-wave-inversions-0#comments Recent M.I. https://www.ecgguru.com/ecg/recent-mi-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/recent-mi-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW%20122%20MI%201%20wk%20ago.jpg" width="3184" height="2006" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a 54-year-old woman who had an M.I. one week prior to this tracing.&nbsp; She did not receive interventional treatment, as it was not available where she lived when this happened years ago. &nbsp;Her ECG shows the signs of healing injury, as well as probable permanent damage.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">Where was this M.I.?</span></strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>The affected leads are all of the precordial leads (V1 through V6), as well as I and aVL.&nbsp;&nbsp; The precordial leads reflect the anterior and low lateral walls of the heart, and Leads I and aVL show us the high lateral wall.&nbsp; This area is perfused by the left coronary artery, and she had a proximal lesion.<strong style="font-size: 13.008px; line-height: 1.538em;"><span style="font-size: 8.0pt; line-height: 107%; color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">&nbsp;</span></strong></p><p class="MsoNormal"><strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">What ST and T wave changes are present?&nbsp;&nbsp;&nbsp; </span></strong>All of the leads listed above show a flattening of the ST segments.&nbsp; While they are no longer elevated (the acute injury is over), they are flat and almost convex upward.&nbsp; This shape is usually abnormal, and it has persisted even though the acute injury is subsiding.&nbsp; The T waves in the anterolateral leads are all inverted.&nbsp; This represents reperfusion of the injured tissue.&nbsp; Whether the offending clot is removed by invasive procedure, thrombolytic drugs, or natural degradation, the tissue that is still alive will reperfuse.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">What else is abnormal?</span></strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">&nbsp;&nbsp;&nbsp;&nbsp; </span>There are pathological Q waves in V1, V2, and V3, or we could say, "loss of normal r waves". &nbsp;Typically,&nbsp;<span style="line-height: 1.538em;">precordial leads begin with an R wave.&nbsp; Lead V1 often has a small r wave, and the size of the R waves progresses across the chest until V6 is almost entirely upright. &nbsp;This is termed "R wave progression". Loss of the initial R wave in the right-sided chest leads is not always indicative of a "pathological Q wave". Also, a small "septal" q wave can sometimes be seen in V5 and V6. &nbsp;True pathological Q waves represent permanently damaged, necrotic myocardium. Poor R wave progression can be a result of pathological Q waves, or other conditions, including incorrect electrode placement. &nbsp;In this ECG, there appears to be a pathological Q wave in Lead III, as well, but isolated Q waves are not uncommon in Lead III, and this patient's current problem is a resolving anterolateral M.I. &nbsp;We don’t know this patient’s clinical status, but we do know that she was still hospitalized, and in the intensive cardiac care unit.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">Is there any good news?</span></strong><span style="color: #2f5597; mso-themecolor: accent5; mso-themeshade: 191; mso-style-textfill-fill-color: #2F5597; mso-style-textfill-fill-themecolor: accent5; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Well, this patient has survived a large and dangerous event so far.&nbsp; She is in normal sinus rhythm with a narrow QRS complex and normal intervals.</p><p class="MsoNormal">For a review of the coronary arteries’ distribution, please see the <a href="http://ecgguru.com/heart-illustrations/coronary-arteries-anterior-view-labeled">coronary arteries</a> illustration in Heart Art.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Recent M.I. 1/5</option><option value="40">Give Recent M.I. 2/5</option><option value="60">Give Recent M.I. 3/5</option><option value="80">Give Recent M.I. 4/5</option><option value="100" selected="selected">Give Recent M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.8</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-YPUdTSXvczjOxINhf_GCMIOK9HBSWhYw438MuwY4LcA" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior M.I.</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/pathological-q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pathological Q waves</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Frecent-mi-0&amp;title=Recent%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 21 Apr 2016 05:07:03 +0000 Dawn 695 at https://www.ecgguru.com https://www.ecgguru.com/ecg/recent-mi-0#comments Deep, Symmetrical T Wave Inversions https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/deep-symmetrical-t-wave-inversions"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/T%20wave%20inversions.jpg" width="1800" height="614" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a 50-year-old man with chest pain.&nbsp; Unfortunately, we don’t have any other clinical information.&nbsp;&nbsp; This tracing is a good example of widespread, symmetrical inverted T waves.&nbsp; Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads).&nbsp; There are ST segment elevations in Leads V1 and V2.&nbsp;<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Many conditions can cause inverted T waves, and bedside assessment is necessary to make a certain diagnosis.&nbsp; Some T wave inversions are benign, such as in persistent juvenile T wave pattern.&nbsp; Some can be due to life-threatening problems like pulmonary embolism, CNS injury, and cardiac ischemia.&nbsp; T wave inversions can be secondary to conditions like left ventricular hypertrophy, left bundle branch block, and ventricular rhythms.&nbsp; When T waves are deep and symmetrical as they are here, they may be a sign of acute coronary syndrome, or cardiac ischemia.&nbsp; Since we know this patient had chest pain, and there is some ST elevation, this should be considered as a cause for his T wave changes.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">In addition to the dramatic T waves, he also has P waves suggestive of “P mitrale”, or left atrial enlargement.&nbsp; The P waves in Lead II are wide (about 10 or 11 ms) and just over 1 mv tall. This is “borderline” for most <a href="http://lifeinthefastlane.com/ecg-library/basics/left-atrial-enlargement/">LAE criteria</a>. &nbsp;&nbsp;The P waves in Lead V1 are biphasic, with the second portion negatively deflected and over 1 mv deep.&nbsp; Acute myocardial infarction can cause left ventricular dysfunction, which can cause backup pressure to the left atrium.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Inverted T waves, like all ST and T wave changes, should always be assessed in the context of the patient presentation, history, and previous ECGs, if available.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p><span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">References:&nbsp; <a href="http://www.consultantlive.com/cardiovascular-diseases/inverted-t-wave-differential-diagnosis-adult-patient">Consultantlive.com, </a>&nbsp;&nbsp;<a href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html">Dr. Ken Grauer</a> </span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Deep, Symmetrical T Wave Inversions 1/5</option><option value="40">Give Deep, Symmetrical T Wave Inversions 2/5</option><option value="60">Give Deep, Symmetrical T Wave Inversions 3/5</option><option value="80" selected="selected">Give Deep, Symmetrical T Wave Inversions 4/5</option><option value="100">Give Deep, Symmetrical T Wave Inversions 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-YUfbtFNim_eQnc3lYqtKj7RReY4UkytFs5zxOBoTb6E" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/coronary-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary syndrome</a></div><div class="field-item odd"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fdeep-symmetrical-t-wave-inversions&amp;title=Deep%2C%20Symmetrical%20T%20Wave%20Inversions"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 16 Dec 2015 03:20:58 +0000 Dawn 680 at https://www.ecgguru.com https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions#comments Inverted T waves in Lateral Wall https://www.ecgguru.com/ecg/inverted-t-waves-lateral-wall <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/inverted-t-waves-lateral-wall"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD108.jpg" width="1800" height="1317" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG was obtained from a 49-year-old man who was a patient in an Emergency Dept. &nbsp;We do not know his presenting complaint, only that he had a history of insulin-dependent diabetes mellitus (IDDM). &nbsp;It was noted by the donor of the ECG that the patient had no chest pain, no shortness of breath, and no other cardiac symptoms. &nbsp;We do not know his hydration or electrolyte status. &nbsp;There are quite a few interesting abnormalities on this ECG, and the exact interpretation would, of course, depend upon the patient's clinical status. &nbsp;It would definitely help to be there!</p> <p>First, we note a sinus tachycardia at a rate of 118 bpm. &nbsp;This could be due to very many causes, including but not limited to: &nbsp;dehydration, pain, anxiety, high or low blood glucose, fever, or CHF. &nbsp;The PR and QT intervals are within normal limits. &nbsp;The QRS complexes are narrow. &nbsp;The axis is normal at 0 degrees. &nbsp;The QRS voltage in the lateral leads is on the high side of normal, but we do not know this patient's body type. &nbsp;Voltage as read by the ECG can be influenced by a thin chest (making voltage look larger) or a large chest (making voltage lower).</p> <p>There are T wave abnormalities in the lateral leads: &nbsp;I, aVL, V5 and V6. &nbsp;The T waves are inverted, which can have many meanings. &nbsp;However, when inverted T waves are in the lateral leads, as opposed to the inferior or right chest leads, it is often a sign of ischemia. &nbsp;The flat, horizontal ST segments can also signify coronary artery disease (CAD). &nbsp;This patient denied cardiac symptoms, but his age and history of IDDM make it probably that CAD is a factor. &nbsp;The leads with T wave inversion also have a small amount of ST segment depression. &nbsp;The right precordial leads, V1 and V2, have a small amount of ST elevation, &nbsp;This possibly represents a reciprocal change to the ST depression in V5 and V6.</p> <p>Because we are not at the bedside of this patient, there are many details we do not know. &nbsp;But these inverted T waves could be ischemic T waves, and this requires that the patient be further evaluated.</p> <p>As always, we welcome comments, as this ECG probably has more to say!</p> <p>&nbsp;</p> <p>REFERENCES: &nbsp;<a href="http://ecg-interpretation.blogspot.com/2012/07/ecg-interpretation-review-47-normal.html">Dr. Ken Grauer</a>, &nbsp;<a title="LITFL T waves" href="http://lifeinthefastlane.com/ecg-library/basic/t-wave/">Life In The Fast Lane</a>, <a title="World J Cardiology" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC43225305/#__ffn_sectitle">World Journal of Cardiology</a>&nbsp;</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Inverted T waves in Lateral Wall 1/5</option><option value="40">Give Inverted T waves in Lateral Wall 2/5</option><option value="60">Give Inverted T waves in Lateral Wall 3/5</option><option value="80" selected="selected">Give Inverted T waves in Lateral Wall 4/5</option><option value="100">Give Inverted T waves in Lateral Wall 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-ro_82URf0ArF3z4EWXG_AJU6ct1dd39kNjJXAndvcoA" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</a></div><div class="field-item odd"><a href="/ecg/pathological-q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pathological Q waves</a></div><div class="field-item even"><a href="/ecg/bi-atrial-enlargement" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bi-atrial enlargement</a></div><div class="field-item odd"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item even"><a href="/ecg/strain-pattern" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Strain pattern</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finverted-t-waves-lateral-wall&amp;title=Inverted%20T%20waves%20in%20Lateral%20Wall"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 11 Nov 2015 02:45:52 +0000 Dawn 676 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inverted-t-waves-lateral-wall#comments Anterior Wall M.I. https://www.ecgguru.com/ecg/anterior-wall-mi-3 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-3"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW109.jpg" width="1800" height="528" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; line-height: normal;"><span style="font-size: small;">This is a very interesting ECG taken from an acute M.I. patient.&nbsp; Your basic level students will be able to appreciate the ST elevation in V1 through V3. Although the elevations are not very high, there are plenty of other abnormalities that point to acute STEMI: the ST segments are flat and there are marked ischemic T waves in the lateral leads: V4 through V6 and I and aVL.&nbsp; The patient was suffering an acute episode of chest pain.</span></p> <p><span style="font-size: small;">It is also noticeable that R wave progression in the precordial leads (V1 through V6) is not optimal, as there is still a significant S wave in V6. &nbsp;We do not know if this is an electrode placement issue or not. &nbsp;The QT interval is just at the high limit of normal. &nbsp;</span><br><span style="font-size: small;">For your more advanced students, aVR has ST elevation.&nbsp; It is not reciprocal of an ST depression in Lead II. &nbsp;Research has shown that ST elevation in aVR and V1, especially when the ST elevation is greater in aVR, is a strong indication of proximal LCA or a Left Main occlusion.&nbsp; Unfortunately, we do not have cath results for this patient. &nbsp;In acute M.I. patients, &nbsp;higher mortality rate has been associated ST elevation in aVR.</span></p> <p style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; line-height: normal;"><span style="font-size: small;">For more information about ST elevation in aVR, click here:&nbsp;<a href="https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5jb20vdmlld2FydGljbGUvNTg5Nzgx&amp;ac=401">https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5jb20vdmlld2FydGljbGUvNTg5Nzgx&amp;ac=401</a></span></p> <p style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; line-height: normal;"><span style="font-size: small;">and here:&nbsp;&nbsp;<a href="http://content.onlinejacc.org/cgi/content/full/38/5/1355">http://content.onlinejacc.org/cgi/content/full/38/5/1355</a></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;">&nbsp;</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Anterior Wall M.I. 1/5</option><option value="40">Give Anterior Wall M.I. 2/5</option><option value="60">Give Anterior Wall M.I. 3/5</option><option value="80" selected="selected">Give Anterior Wall M.I. 4/5</option><option value="100">Give Anterior Wall M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-57JjAgA1TxI_GQR-r4vVkw9V79Dp4PYpSvqcfZJroAk" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-5" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior wall M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanterior-wall-mi-3&amp;title=Anterior%20Wall%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 26 Jul 2015 19:10:35 +0000 Dawn 653 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anterior-wall-mi-3#comments Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. https://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/6.jpg" width="1800" height="1089" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG is the last in a series of 6 that were donated by&nbsp;<span style="line-height: 1.538em;">Jenda Enis Štros showing the evolutionary changes of an M.I. from onset, through spontaneous reperfusion, angioplasty, re-occlusion by thrombus, and recovery. &nbsp;This ECG shows deep precordial T wave inversions, an expected evolutionary change after reperfusion of an occluded artery - in this case, the left anterior descending. &nbsp;The patient has lost some of his QRS amplitude (viable heart muscle), but has not developed pathological Q waves. &nbsp;Pathological Q waves would indicate full-thickness necrosis of the wall, which is usually a permanent injury. &nbsp;</span></p><p><span style="line-height: 1.538em;">The patient was discharged home with a 45% ejection fraction (60% is ideal), and he had akinesis of part of his anterior wall. &nbsp;This can be permanent or temporary, and followup studies would be needed to evaluate the ongoing health and function of the left ventricle.</span></p><p><span style="line-height: 1.538em;">Here are links to all six ECGs from this series:</span></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-1-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-1-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-2-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-2-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-3-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-3-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-5-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-5-6-acute-anterior-wall-mi</a></p><p>&nbsp;</p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi</a></p><p class="MsoNormal">&nbsp;</p><p><span style="line-height: 1.538em;"><br /></span></p><p class="MsoNormal">&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--6" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--12" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. 1/5</option><option value="40">Give Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. 2/5</option><option value="60">Give Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. 3/5</option><option value="80">Give Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. 4/5</option><option value="100">Give Teaching Series 1113: ECG 6 of 6 - Acute Anterior Wall M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-TxTyRseM9-Pw2PRZHqduvhB9SMkMidkxzW3Oa3WRdOg" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-5" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior wall M.I.</a></div><div class="field-item odd"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item even"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/reperfusion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Reperfusion</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fteaching-series-1113-ecg-6-6-acute-anterior-wall-mi&amp;title=Teaching%20Series%201113%3A%20%20ECG%206%20of%206%20%20-%20%20Acute%20Anterior%20Wall%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 16 Dec 2013 02:25:00 +0000 Dawn 531 at https://www.ecgguru.com https://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi#comments Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. https://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/4.jpg" width="1800" height="964" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Continuing our teaching series of ECGs donated by&nbsp;<span style="line-height: 1.538em;">Jenda Enis Štros, ECG 4 of 6 shows a new occurance of huge T wave inversions in the precordial leads. &nbsp;Since this is the area that was stented (left anterior descending artery, anterior wall of the LV), we immediately should think of re-occlusion of the artery. &nbsp;In a newly-placed stent, the danger is thrombosis (blood clot). &nbsp;The patient had no chest pain at this time.</span></p><p><span style="line-height: 1.538em;">Here are links to all six of the ECGs in this series:</span></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-1-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-1-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-2-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-2-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-3-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-3-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi</a></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-5-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-5-6-acute-anterior-wall-mi</a><span style="line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><a href="http://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi">http://www.ecgguru.com/ecg/teaching-series-1113-ecg-6-6-acute-anterior-wall-mi</a></p><p class="MsoNormal">&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--7" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--14" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. 1/5</option><option value="40">Give Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. 2/5</option><option value="60">Give Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. 3/5</option><option value="80">Give Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. 4/5</option><option value="100">Give Teaching Series 1113: ECG 4 of 6 - Acute Anterior Wall M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-SmIWgeP0Gtf-srN0sNGWSkBj8WcNpd7icFfYEM_2L1s" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-5" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior wall M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fteaching-series-1113-ecg-4-6-acute-anterior-wall-mi&amp;title=Teaching%20Series%201113%3A%20%20ECG%204%20of%206%20%20-%20%20Acute%20Anterior%20Wall%20M.I.%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 16 Dec 2013 02:07:44 +0000 Dawn 529 at https://www.ecgguru.com https://www.ecgguru.com/ecg/teaching-series-1113-ecg-4-6-acute-anterior-wall-mi#comments Lateral Ischemia and Previous MI In a Patient With Chest Pain https://www.ecgguru.com/ecg/lateral-ischemia-and-previous-mi-patient-chest-pain <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/lateral-ischemia-and-previous-mi-patient-chest-pain"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD102_0.jpg" width="1400" height="741" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>During our summer break, we are reprising a few of the best ECGs from our archives, to give you a chance to comment or to ask questions.</p><p>This ECG was taken from a 52 year old man who was complaining of chest pain, with a history of severe multi-vessel disease. He has a history of M.I. and states he has five coronary stents.</p><p>His pain was partially relieved by Ntg., and he was given aspirin in the field, and then IV Ntg., Integrelin, and morphine before being sent to the cath lab. This ECG shows T wave inversions with coved upward ST segments, but no ST elevation in the lateral leads: I and aVL, and the anterior-lateral leads, V3 through V6. This represents the territory covered by the left coronary artery, and points to a lesion in the proximal portion of the artery. Also in this ECG are pathological Q waves in right side leads, III, V1 and V2.</p><p>In the cath lab, he was discovered to have a ruptured plaque in the proximal LAD, with some blood getting through a very narrow channel. He was referred for coronary artery bypass surgery the next day.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--8" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--16" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Lateral Ischemia and Previous MI In a Patient With Chest Pain 1/5</option><option value="40">Give Lateral Ischemia and Previous MI In a Patient With Chest Pain 2/5</option><option value="60">Give Lateral Ischemia and Previous MI In a Patient With Chest Pain 3/5</option><option value="80" selected="selected">Give Lateral Ischemia and Previous MI In a Patient With Chest Pain 4/5</option><option value="100">Give Lateral Ischemia and Previous MI In a Patient With Chest Pain 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-rjezuaPovrGuAORSC4GOSfmxJk6PrbTkW6AAA6HmY44" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/pathological-q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pathological Q waves</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Flateral-ischemia-and-previous-mi-patient-chest-pain&amp;title=Lateral%20Ischemia%20and%20Previous%20MI%20In%20a%20Patient%20With%20Chest%20Pain"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 10 Jan 2012 04:48:00 +0000 Dawn 154 at https://www.ecgguru.com https://www.ecgguru.com/ecg/lateral-ischemia-and-previous-mi-patient-chest-pain#comments Coronary Artery Disease https://www.ecgguru.com/ecg/coronary-artery-disease <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/coronary-artery-disease"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD100.jpg" width="1400" height="1037" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG was taken from a 49 year old man with insulin-dependent diabetes, with no complaints of cardiac symptoms.&nbsp;&nbsp;The rest of this patient's history is lost.&nbsp; &nbsp;This is a great ECG for demonstrating the flat ST segments and T wave inversion of ischemia due to coronary artery disease. The ECG changes are&nbsp;very noticeable in the lateral wall.&nbsp; It is not known why the patient presented with sinus tachycardia.<br /><br />&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/229/feed" method="post" id="fivestar-custom-widget--9" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--18" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Coronary Artery Disease 1/5</option><option value="40">Give Coronary Artery Disease 2/5</option><option value="60">Give Coronary Artery Disease 3/5</option><option value="80">Give Coronary Artery Disease 4/5</option><option value="100">Give Coronary Artery Disease 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--9" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-pfOoCS5NYQaZvPNgZlht2rjmW55AmDQnba-wRc5MenE" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fcoronary-artery-disease&amp;title=Coronary%20Artery%20Disease"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 31 Oct 2011 19:11:40 +0000 Dawn 47 at https://www.ecgguru.com https://www.ecgguru.com/ecg/coronary-artery-disease#comments