PRIMARY & SECONDARY T-WAVE CHANGES OF THE LBBB & RBBB If you find an LBBB or RBBB you must further analyze all the T-Waves to categorize them as either Primary or Secondary. We have discussed at length in previous blog posts the distortions which the LBBB can create when analyzing the 12-lead ECG in the presence of a Left Bundle Branch Block. T-wave Inversions and Changes Associated with RBBB or LBBB Recommend clinical correlation and comparison with old tracingĢ.Cannot rule out myocardial infarction/ischemia (anterolateral) or reciprocity.is it simply LVH with ST-T changes or is there associated ischemia and/or infarction? This screening decision is made by careful analysis of the history, physical exam, X-ray, coronary risk factors, comparison with the old ECG and lab studies including the cardiac markers. In a given situation the practitioner must correlate clinically in order to determine the interpretation and disposition response i.e. As a safety net of hedging, please know that it is wise to acknowledge that the observed changes could be a combination of:ī….ST-T-Q changes of the acute STEMI/non-STEMI or myocardial ischemia This will swing you in the direction to simply conclude:Ģ. This might inform you that these ST-T-Q wave changes are old. Always ask to to see the old cardiogram.The recognition of these changes associated with the LVH pattern should automatically trigger your mentality to: These three leads will frequently demonstrate ST-T-Q waves that will mimic the acute ST elevation MI. This potential catastrophe can be avoided or minimized by being proactive with your thinking when you recognize the LVH pattern i.e.īe particularly vigilant with your interpretation regarding Leads V1, V2 and V3. You can clearly see how one might misinterpret this cardiogram as an acute STEMI. These observed ST-T-Q wave changes look like those of the acute anteroseptal ST elevation MI, but in fact these changes are probably pseudoinfarction changes. This tracing is a particularly good example of significantly wide Q-waves and ST elevation concave down commonly found in Leads V2, and V3. The focus of this Case Study tracing is to emphasize changes often found secondary to the LVH pattern. LESSON NOTE ON Q-WAVES AND ST-ELEVATION ASSOCIATED WITH THE LVH PATTERN This tracing is a particularly good example of ST-T changes that mimic the Acute Anteroseptal MI. The focus of this Case Study is the LVH pattern and its associated ST-T changes. When compared, they are virtually identical. Please know that an old tracing was available. ST depression and T-wave inversion Leads V6, I, aVL, II.Peaked T’s and ST elevation and significant Q’s in Leads V1 andV2.LVH with ST-T changes (strain) criteria R-wave = 19 mm Lead avL.T-wave Inversion Associated with LVH Example LVH Tracing (C) 2022 Vernon R Stanley, MD, PhD &, LLC T-wave inversion of Ischemia or non-ST Elevation MIġ.T-wave inversion Associated with LBBB or RBBB.In this blog we will focus briefly on the following T-wave inversion causes as is featured on Dr Stanley’s HEART Ruler Pocket Guide: See full article.)Ī focus on “B” in the diagram above illustrates T-wave Inversion (If T-wave inversion a new finding, it may be associated with increased hospitalization, mechanical ventilation and increased mortality.
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