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Strip Tease 3


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If you double click on the strip it gets bigger.

If you enlarge the image when you click on the part where it says to click to enlarge and it opens a new window click and hold the control key on your keyboard and then hit the + key. It will enlarge the image even larger as many times as your click it. If you do the same, but use the - key, it will make it smaller. This also works for normal web page viewing. It works in firefox, and internet explorer.

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The negative deflections point me to some form of bundle branch block meaning the electrical impulse is travelling in a different direction than towards the positive lead (creating positive deflection).

I am also seeing some ST elevation in II, III, aVR, aVF

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The negative deflections point me to some form of bundle branch block meaning the electrical impulse is travelling in a different direction than towards the positive lead (creating positive deflection).

I am also seeing some ST elevation in II, III, aVR, aVF

Did you not read the preceding posts before reviving this dead post? It is a paced rhythm and thus you can make NO conclusions about ST segment - abnormal depolarization means abnormal repolarization - Look at V4, V5 for the spikes.

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Did you not read the preceding posts before reviving this dead post? It is a paced rhythm and thus you can make NO conclusions about ST segment - abnormal depolarization means abnormal repolarization - Look at V4, V5 for the spikes.

That's not entirely true. You just have to understand the expected appearance of the ST segments and T waves in the context of paced rhythm (which is similar to that of LBBB). In the presence of paced rhythm, the ST segment and T wave should be deflected opposite the main vector of the QRS complex (which is also the terminal deflection). The concept is "appropriate ST segment and T wave discordance". Any ST segment elevation in a lead with an upright QRS complex is abnormal. In a lead with a negative QRS complex, the deeper the S wave, the higher the ST segment elevation (normal finding with paced/LBBB). When the ST elevation is greater than 0.25 the QRS complex, it's abnormal and usually indicates AMI. ST depression is a lead that shows a negative QRS complex is also abnormal and often indicates AMI (inappropriately concordant ST segment depression).

Tom

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I really don't believe that without previous 12 leads on this patient that you can make any determination as to what is "normal" for this patient and what is elevation. I appreciate your obvious knowledge re: 12 lead interpretation but my statements are directly related to what I can and cannot do in the field. If I was in the hospital setting with history on this patient, then I guess I would learn this cool stuff.

The same goes for LBBB. 12 lead interpretation stops. That does not mean that I don't treat the patient. Signs and symptoms of acute cardiac will be treated per protocol. I just wouldn't make any statements of ST elevations, etc.

Edited by Kaisu
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