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There are Q-waves, and the highly elevated troponin I confirms prolonged infarct. This is a large anterior STEMI with persistent pain and ST elevation. When there is subacute STEMI, the thrombolytic decision must be made carefully with attention to both risk and benefit. The ECG is, in fact, an even better measure of acuteness of a STEMI.
#IVCD INTRAVENTRICULAR CONDUCTION DELAY FULL#
(Sorry, no full text here: this is an analysis of thrombolytic trials from 1983-1993, and found that if pain has been present for 6-12 hours, then a mean of 18 lives were saved per 1000 patients treated with lytics vs. Thrombolytics are still recommended up to 12 hours after the onset of pain. He recovered well and was discharged several days later. These are signs of pr evious MI, or of well developed "subac ute" acute MI.Īll of th ese ECG findings, along with the clinical scen ario, are all but diagnostic o f a suba cute STEMI in the s etting of LBBB. These are reminiscennt of " Cabrera's sign" (a notch greater than 50 ms on the ascending limb of the S-wave in one of V3-V5). There is also a notch on the ascending limb of the S-wave in V2 and also slightly in V3. Thus, leads V4 and V5 are diagnostic of STEMI.įurthermore, one expects a small R-wave in V1 and V2 in LBBB. In LBBB, ST-T is normally discordant to the majority of the QRS, but is that "majority" measure by voltage (in mm of amplitude), or is it best measured by area under the curve? In this case, in V5 the R-wave amplitude is greater, but the S-wave area is greater. Stated in other words: The "area under the curve" or "integral" is all the area contained between the waveform and the isoelectric line. What matters most? Is it the voltage? Or is it the integral (area under the curve) that matters most? In any case, the difference in voltage and in area is not great, and therefore there should be almost no ST deviation in that lead. How about lead V5? The S-wave and R-wave are of nearly equal voltage on the other hand, the S-wave is slightly wider than the R-wave.
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Lead V4 alone would make this ECG "modified Sgarbossa positive"( reference 1, reference 2): it has a 3mm S wave withĢ.5mm of ST elevation, making a STE/S ratio of 0.83. Is there concordant ST elevation? This depends on whether the QRS is mostly positive or mostly negative in lead V5 if positive, then the ST elevation is indeed concordant. Is "Sgarbossa negative." There is no concordant ST depression in V1-V3, and no ST elevation equal or The treating physicians documented that this ECG It has morphology very similar to LBBB: there is a wideĬomplex with dominant S waves in the anterior leads, so we presumably can apply the The computerized QRSĭuration is 120ms, qualifying this for an Intraventricular Conduction Delay.