MedAll-Talk #5 (Blog 351 — Nov. 2, 2023) — Used for Blog #406

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NOTE: These are my "slides" for November 2, 2023 — for my MedALL presentation. The talk will be recorded and posted on-line.

• Based on ECG Blog #351 (www.tinyurl.com/KG-Blog-351 )
• LINK to this Page — www.tinyurl.com/KG-MedAll-351 —  
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• LINK to VIDEO of My Talk (November 2, 2023) — 

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Figure-4: ECG findings to look for when your patient with new-onset cardiac symptoms does not manifest STEMI-criteria ST elevation on ECG. For more on this subject — SEE the September 3, 2020 post in Dr. Smith’s ECG Blog with 20-minute video talk by Dr. Meyers on The OMI Manifesto. For my clarifying Figure illustrating T-QRS-D (2nd bullet) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post.

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ECG Blog #205 = The Systematic Approach I favor ...

• The "formula" = https://tinyurl.com/KG-Blog-2XX
• LINK for Blog #205 = https://tinyurl.com/KG-Blog-205 -

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Figure: The Systematic Approach that I favor. Review of the first 4 parameters in Descriptive Analysis (Rate; Rhythm; Intervals; Axis). NOTE: IF the QRS complex is wide — then STOP and find out WHY the QRS is wide before proceding to assessment of Axis, Chamber Enlargement and QRST Changes. This is because IF the QRS is wide because of BBB (Bundle Branch Block) — criteria for axis, hypertrophy, and ST-T wave changes will be different when there is BBB or IVCD! To emphasize, IF the QRS is wide — this is the ONE time that I depart from the sequence in Figures-2 and -3 (P.S. IF the QRS is wide — Make sure that the rhythm is not VT. If the rhythm is sinus — ECG Blog #204 reviews how to determine if RBBB, LBBB or IVCD is present).

 

Figure: The Systematic Approach that I favor (Continued). Review of the last 2 parameters in Descriptive Analysis (Chamber Enlargement; Looking for Q-R-S-T Changes) — and then formulating your Clinical Impression.

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Figure-2: I've added the mirror-image of leads V3 and V4 to today's tracing — to illustrate how the initial ECG shows a positive "Mirror" Test suggestive of acute posterior OMI (See text).

Figure-3: Comparison of the initial ECG — with a repeat ECG done 18 minutes later (substituting leads V4R,V8,V9 — for leads V4,V5,V6). Of note — the patient reported a reduction in chest pain severity around the time ECG #2 was recorded.

Figure-4: ECG findings to look for when your patient with new-onset cardiac symptoms does not manifest STEMI-criteria ST elevation on ECG. For more on this subject — SEE the September 3, 2020 post in Dr. Smith’s ECG Blog with 20-minute video talk by Dr. Meyers on The OMI Manifesto. For my clarifying Figure illustrating T-QRS-D (2nd bullet) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post.

Figure-5: KEY points in the recognition of isolated posterior MI (This figure is taken from ECG Blog #193 — in which I review the "Basics" for predicting the "culprit" artery).