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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, February 14, 2014

ECG avanzado

Emergency Medicine in the South Bronx - February 12, 2014
"Dr. Amal Mattu gave a fantastic lecture on advanced EKG interpretation at the AAEM Conference in NYC today. For those who were unable to attend, here are some highlights:
  1. Sgarbossa Criteria helps diagnose an acute MI in the setting of an LBBB. Concordance bad. Discordance good (but TOO much discordance is bad too). Elegantly shown from EMS12lead.com – http://tinyurl.com/ndw285
  2. Wellens Syndrome describes T wave changes indicating a proximal LAD lesions.Type 1 are deep, symmetric TWI which hit you square in the face and Type 2 are subtle, biphasic changes. Nicely displayed here: http://pages.mrotte.com/wellens/five.png
  3. Posterior MIs present as ST depressions in V1-V3 with tall R waves (N.B., the R waves are actually evolving Q Waves) Get a posterior lead EKG to look for ST Elevations (Leads V7-V9: http://lifeinthefastlane.com/wp-content/uploads/2011/09/posterior-leads.gif)
  4. aVR: unloved, forgotten. Elevations here can be indicative of LMCA, proximal LAD occlusions. Bad, bad, bad.
  5. STEMI vs Pericarditis? Keep this in mind: 
    1. ST Elevations with reciprocal ST Depressions anywhere (except aVr or V1) = STEMI 
    2. ST Elevation greater in V3 than V2 = STEMI
    3. Morphology of ST Segment is either convex or flat = STEMI
  6. BER
  7. aVL changes can present as early reciprocal changes of impending doom. A TWI in this lead alone might evolve into an inferior wall STEMI.
  8. Hyperacute T Wave – not just tall, pointy, and would hurt to sit on… but also can present subtlety… of normal height… with a straight initial up-sloping of a T wave."