{"id":782,"date":"2018-09-05T00:01:22","date_gmt":"2018-09-05T00:01:22","guid":{"rendered":"http:\/\/torreyekg.com\/?p=782"},"modified":"2018-08-24T14:03:45","modified_gmt":"2018-08-24T14:03:45","slug":"ekg-of-the-week-58","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2018\/09\/05\/ekg-of-the-week-58\/","title":{"rendered":"EKG of the Week #58"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM.png\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM.png\" alt=\"\" width=\"1404\" height=\"356\" class=\"alignnone size-full wp-image-783\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM.png 1404w, http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM-300x76.png 300w, http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM-768x195.png 768w, http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/07\/Screen-Shot-2018-07-25-at-9.12.53-PM-1024x260.png 1024w\" sizes=\"auto, (max-width: 1404px) 100vw, 1404px\" \/><\/a><br \/>\nEMS 12-lead transmit:<\/p>\n<p>\u201c56-year-old man with chest discomfort and SOB\u201d<br \/>\nWould you call a STEMI alert? <\/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 \/>\nYES!  This is an acute anterolateral STEMI occurring with a RBBB.  Unlike its cousin, a LBBB, a RBBB does not obscure ischemia and infarct patterns.  Again, it is important to be familiar with some expected repolarization changes with a RBBB (essentially T-wave inversion in V1-3, leads with the most obvious depolarization changes).\n<p>This EKG is impressive for the ST-segment elevation in leads V2-4, including \u201cgiant R waves\u201d in V4-5, the earliest signs of STEMI.  There does seem to be subtle, probably early, reciprocal ST-segment depression in the inferior leads, supporting the diagnosis of STEMI.<\/p>\n<p>If you were questioning, or not embracing, this unique and fairly rare EKG of a RBBB with an acute STEMI, look at the second EMS transmission that occurred 10 minutes later\u2026<br \/>\n<a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/08\/Screen-Shot-2018-07-25-at-9.15.12-PM.png\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/08\/Screen-Shot-2018-07-25-at-9.15.12-PM.png\" alt=\"\" width=\"946\" height=\"258\" class=\"alignnone size-full wp-image-785\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/08\/Screen-Shot-2018-07-25-at-9.15.12-PM.png 946w, http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/08\/Screen-Shot-2018-07-25-at-9.15.12-PM-300x82.png 300w, http:\/\/torreyekg.com\/wp-content\/uploads\/2018\/08\/Screen-Shot-2018-07-25-at-9.15.12-PM-768x209.png 768w\" sizes=\"auto, (max-width: 946px) 100vw, 946px\" \/><\/a><br \/>\nST-segment elevation in V2-5, as well as ST- and T-wave changes in I, aVL and V6; notice also the T-wave inversion in III, a reciprocal change to the anterior-lateral infarct.<br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>EMS 12-lead transmit: \u201c56-year-old man with chest discomfort and SOB\u201d Would you call a STEMI alert?<\/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-782","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\/782","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=782"}],"version-history":[{"count":3,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/782\/revisions"}],"predecessor-version":[{"id":787,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/782\/revisions\/787"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=782"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=782"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=782"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}