tag:blogger.com,1999:blog-18943510.post4920938234705801947..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du JourDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-18943510.post-40039034022772349802009-03-28T10:41:00.000-05:002009-03-28T10:41:00.000-05:00LW-The "J-point" is the location where the ST segm...LW-<BR/><BR/>The "J-point" is the location where the ST segment connects to the QRS complex. The "J-wave" on an EKG is seen in hypothermia, and is more commonly called an "Osborn Wave." The Osborn wave is also is found at the junction of the QRS complex and ST segment and has a characteristic appearance. A good example of this can be seen <A HREF="http://stroke.ahajournals.org/cgi/content/DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-40347116947357401712009-03-27T20:28:00.000-05:002009-03-27T20:28:00.000-05:00Dear Dr. Fisher,Up to which part of ST segment is ...Dear Dr. Fisher,<BR/>Up to which part of ST segment is J Wave?<BR/>Thanks,<BR/>LWUnknownhttps://www.blogger.com/profile/12527689974345072416noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-35884369938494935052008-01-23T17:49:00.000-06:002008-01-23T17:49:00.000-06:00Anony 10:37-Given the family hx of sudden cardiac ...Anony 10:37-<BR/>Given the family hx of sudden cardiac arrest in the family, I would do provocative testing in sibs/immediate family members that do not have definitive signs of Brugada.<BR/><BR/>CardioNP-<BR/>Your case is less clear: primarily because of the family history of "pre-syncope" and unusual baseline EKG. I suspect it's not a "cut-and-dry" case, like this case study. Unfortunately, DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-57614594374415582922008-01-23T15:27:00.000-06:002008-01-23T15:27:00.000-06:00My guess was Brugada as well.Tx ICD.Happy - FYI -T...My guess was Brugada as well.<BR/>Tx ICD.<BR/><BR/>Happy - FYI -<BR/>Tarascon's Internal Medicine and Critical Care Pocketbook has a "cheat sheet" page on EKG findings in Brugada.<BR/><BR/>We had a recent consult on a 20 something yo pt whose sibling had a pre-syncopal episode, was evaluated at another facility and had an ICD placed for dx of Brugada. My attending wanted to confirm the dx in Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-63988829437582826082008-01-22T22:37:00.000-06:002008-01-22T22:37:00.000-06:00would you bring other siblings to the ep lab witho...would you bring other siblings to the ep lab without this ekg finding and try and induce it?<BR/>thanksAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-70000391622466616082008-01-22T15:36:00.000-06:002008-01-22T15:36:00.000-06:00Happy-The classic finding here is the "j-wave" fou...Happy-<BR/><BR/>The classic finding here is the "j-wave" found in V1->V3 at the end of the QRS complex. The "J-point" is where the QRS ends and the ST segment begins. This EKG is classic for a profoundly positive (>2 mm) J wave (not just J point) with its associated convex-up ST segment, followed by a negative last 1/2 of the T wave, suggestive of a Type I Brugada syndrome. More can be found DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-53921203759508675362008-01-22T14:51:00.000-06:002008-01-22T14:51:00.000-06:00dr Wes, can you guide me throught the "classic" E...dr Wes, can you guide me throught the "classic" EKG findings in Brugada.<BR/><BR/>HappyThe Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-52047054461882466252008-01-22T14:37:00.000-06:002008-01-22T14:37:00.000-06:00R.W.-Ah, the seasoned vet wins again. Well done! ...R.W.-<BR/><BR/>Ah, the seasoned vet wins again. Well done! (Here's the <A HREF="http://doctorrw.blogspot.com/2005/12/do-not-miss-this-diagnosis.html" REL="nofollow">link</A> with references to RW's blog that does a better job of explaining than I could). A previously -performed EKG disclosed no left ventricular hypertrophy and normal cardiac morphology. Blood of the patient and his relatives DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-62686208777036282732008-01-22T13:28:00.000-06:002008-01-22T13:28:00.000-06:00Here's my differential diagnosis:1) Brugada syndr...Here's my differential diagnosis:<BR/><BR/>1) Brugada syndrome<BR/>2) Brugada syndrome<BR/>3) Brugada syndrome<BR/><BR/>Management? THe patient needs Dr. Wes!<BR/><BR/>The indications for a device may be a bit controversial for an asymptomatic patient. I'll leave that, and whether to do a procainamide challenge test or some other challenge test to Dr. Wes and those of his ilk. Nice look-seeRobert W Donnellhttps://www.blogger.com/profile/16944231400440786271noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-13370133169104771792008-01-22T13:10:00.000-06:002008-01-22T13:10:00.000-06:00Eric - Not quite, tho' I smiled when I read your s...Eric - <BR/>Not quite, tho' I smiled when I read your suggestions. Don't feel bad - you're trying and that's what matters.<BR/><BR/>Artemis - <BR/>In the differential is LVH, but this just doesn't cut it here (discussion later). EP nerds like myself see this EKG as a "classic" but unfortunately it often goes unrecognized. Hence why it was posted.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-34422833308224159892008-01-22T13:04:00.000-06:002008-01-22T13:04:00.000-06:00Wellens sign, (biphasic t waves in V2 and V3) sugg...Wellens sign, (biphasic t waves in V2 and V3) suggests proximal LAD lesion. Patient needs angiography STAT, probable angioplasty and/or stent placement. Brother's history suggests bad genes, so blood pressure and cholesterol evaluation and (likely) lifestyle modification should be underway as well. <BR/><BR/>Am I right? <BR/>AArtemishttps://www.blogger.com/profile/15321501062140234923noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-27598603598811344572008-01-22T12:49:00.000-06:002008-01-22T12:49:00.000-06:00As the rankest of rank amateurs, can I go first so...As the rankest of rank amateurs, can I go first so everybody can laugh?<BR/><BR/>My guess is left ventricular hypertrophy, based on what looks to my untrained eye like a little "lumpiness" of the P-wave in lead I, and the relatively large Rs in V4-6 and aVL. <BR/><BR/>I guess I'd refer him for an echo or a nuclear stress test, depending on the thickness and luxuriousness of his insurance card.<Eric, AKA The Pragmatic Caregiverhttps://www.blogger.com/profile/10006690628166460007noreply@blogger.com