{"id":700,"date":"2017-03-20T00:01:14","date_gmt":"2017-03-20T00:01:14","guid":{"rendered":"http:\/\/torreyekg.com\/?p=700"},"modified":"2017-03-13T13:57:51","modified_gmt":"2017-03-13T13:57:51","slug":"ekg-of-the-week-47","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2017\/03\/20\/ekg-of-the-week-47\/","title":{"rendered":"EKG of the Week #47"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/47.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-711\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/47.png\" alt=\"\" width=\"647\" height=\"347\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/47.png 647w, http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/47-300x161.png 300w\" sizes=\"auto, (max-width: 647px) 100vw, 647px\" \/><\/a><br \/>\n60-year-old man presents with right-sided hemiparesis and aphasia. What do you make of these EKG changes?<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Answer &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nEKG interpretation<br \/>\n\tSinus at 100\/minute<br \/>\n\tAxis is normal<br \/>\n\tIntervals are normal<br \/>\n\tIschemia\/infarct \u2013 T wave inversion V1-4 with loss R waves (deep Q waves) in the same leads\n<p>T-wave inversion in the anterior leads has a broad differential.  Deep, or giant, T-wave inversion has it\u2019s own differential including CNS changes  (see full differential under Impressive T-wave Inversion on TorreyEKG.com).  More minor T-wave inversion can be seen with ischemia, acute PE, evolving or subacute STEMI, and many other causes.<\/p>\n<p>These T-wave inversions in leads with well-formed Q waves suggest a subacute MI, possibly days to weeks old (the Q\u2019s have formed, the ST-segments are back close to baseline, but the T-wave inversion can persist for weeks).<\/p>\n<p>And what is the connection between a recent anterior MI and his presentation with a stroke?  Once anticoagulated on heparin, a transesophageal ultrasound showed a large mural thrombus in a dyskinetic wall of his left ventricle.<br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>60-year-old man presents with right-sided hemiparesis and aphasia. What do you make of these EKG changes?<\/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-700","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\/700","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=700"}],"version-history":[{"count":4,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/700\/revisions"}],"predecessor-version":[{"id":713,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/700\/revisions\/713"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=700"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=700"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}