{"id":473,"date":"2016-02-28T00:01:41","date_gmt":"2016-02-28T00:01:41","guid":{"rendered":"http:\/\/torreyekg.com\/?p=473"},"modified":"2016-02-11T03:26:22","modified_gmt":"2016-02-11T03:26:22","slug":"ekg-of-the-week-21","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2016\/02\/28\/ekg-of-the-week-21\/","title":{"rendered":"EKG of the Week #21"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/21.png\" rel=\"attachment wp-att-474\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-474\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/21.png\" alt=\"21\" width=\"648\" height=\"361\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/21.png 648w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/21-300x167.png 300w\" sizes=\"auto, (max-width: 648px) 100vw, 648px\" \/><\/a><br \/>\nAny concerns?<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Interpretation &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nFirst the rhythm \u2013 sinus bradycardia at 36\/minute\n<p>Second \u2013 the inferior leads keep catching my eye\u2026no obvious ST-segment elevation, but the T waves look a bit prominent (hyperacute ?), and then there is the T wave inversion in aVL (remember, reciprocal changes in aVL may be the earliest sign of an inferior MI).<\/p>\n<p>Of course, the correct response would be to repeat the EKG. This was done just 10 minutes later:<br \/>\n<a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/212.png\" rel=\"attachment wp-att-475\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-475\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/212.png\" alt=\"212\" width=\"432\" height=\"241\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/212.png 432w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/212-300x167.png 300w\" sizes=\"auto, (max-width: 432px) 100vw, 432px\" \/><\/a><br \/>\nNow the inferior STEMI is evident! Note the rhythm change \u2013 now sinus at 100\/minute, and with more prominent P waves. Not having been there, I can only guess \u2013 the original rate was likely due to excess vagal tone (common with inferior MI\u2019s \u2013 think pale, diaphoretic, nauseous, bradycardic). The subsequent tachycardia might be due to nitroglycerin administration, or just less vagal tone, or maybe they received atropine.<\/p>\n<p>Keep repeating those EKGs when rhythm or rate changes; you could be looking at an early MI<br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Any concerns?<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-473","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/473","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=473"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/473\/revisions"}],"predecessor-version":[{"id":477,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/473\/revisions\/477"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=473"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=473"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=473"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}