{"id":764,"date":"2018-07-26T00:04:36","date_gmt":"2018-07-26T00:04:36","guid":{"rendered":"http:\/\/torreyekg.com\/?p=764"},"modified":"2018-07-26T00:05:41","modified_gmt":"2018-07-26T00:05:41","slug":"ekg-of-the-week-55","status":"publish","type":"post","link":"https:\/\/torreyekg.com\/index.php\/2018\/07\/26\/ekg-of-the-week-55\/","title":{"rendered":"EKG of the Week #55"},"content":{"rendered":"

\"\"<\/a>
\nIs this a STEMI?
\nIs there another explanation for ST and T-wave changes seen<\/p>\n

Answer & Explanation<\/div>

\nThis EKG is important for emergency medicine providers. It is commonly seen in presentations of chest pain, and it is one of the most difficult of EKG patterns for ED physicians to interpret definitively.\n

Let\u2019s return to a systematic review of the EKG\u2026
\n\tRate\t\t60\/minute
\n\tRhythm\tSinus rhythm with no ectopy
\n\tAxis\t\tLeftward axis at -30\u00b0
\n\tIntervals\tPR \u2013 160msec, QRS \u2013 110msec (slightly prolonged), QTc \u2013 normal
\n\tChamber enlargement \u2013 LVH voltage because R\u226512mm in aVL
\n\tIschemia & Infarct \u2013 slight ST-elevation V1-3<\/p>\n

While ST-segment elevation in the anterior leads may be the most concerning feature of this EKG on a cursory evaluation, there may be an alternative, and more appropriate, explanation.<\/p>\n

In this EKG we have LVH by voltage criteria, plus several factors that suggest the diagnosis of severe LVH. These include:
\n\t1. ST-depression\/T inversion in lateral leads \u2013 a \u201cstrain pattern\u201d
\n\t2. left axis deviation
\n\t3. prolongation of the QRS complex (delayed depolarization due to increased size of the ventricle)
\n\t4. repolarization changes, including ST-elevation in anterior leads
\nAs LVH becomes more severe, the changes on the EKG begin to resemble those of LBBB. Notice, however, that normal small Q waves (\u201cseptal Q waves\u201d) remain in the lateral leads (I, aVL, V5-6). These Q waves signify that the LBBB is still functioning and provides depolarization of the septum!<\/p>\n

Sometimes it takes some skill and confidence to NOT call a consultant!
\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

Is this a STEMI? Is there another explanation for ST and T-wave changes seen<\/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-764","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/764","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=764"}],"version-history":[{"count":3,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/764\/revisions"}],"predecessor-version":[{"id":768,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/764\/revisions\/768"}],"wp:attachment":[{"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=764"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=764"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=764"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}