Amal Mattu’s ECG Case of the Week – April 13, 2015 To view the remainder of this post you must be logged in or have an ECGWeekly account. Log In Click here to purchase an annual account By ECGWeekly Support|2016-12-21T17:14:56-04:00April 12th, 2015|7 Comments Share This Story, Choose Your Platform! FacebookTwitterLinkedInGoogle+TumblrPinterestEmail Related Posts Amal Mattu’s ECG Case of the Week – October 21, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 21, 2019 Amal Mattu’s ECG Case of the Week – October 14, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 14, 2019 Amal Mattu’s ECG Case of the Week – October 7, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 7, 2019 Amal Mattu’s ECG Case of the Week – September 30, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 30, 2019 Amal Mattu’s ECG Case of the Week – September 23, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 23, 2019 7 Comments rajiv a April 13, 2015 at 10:15 am Log in to Reply DEAR SIR Thanks for resolving the broadcast problems.How can we see your past videos done with umem . Secondly ,many patients in ED present with TWI in Inferior as well as Anterior leads (like the the last two examples in your video)and in my experience ,they never turned out to be a case of PE. My question in this context is that what is the DDx percentage vise in Inferior plus Anterior Vs. Inferior Plus Antero Septal TWI. thanks Dr.Rajiv Arora Jared T April 13, 2015 at 2:37 pm Log in to Reply Wonderful case! David B April 18, 2015 at 12:54 pm Log in to Reply Great lecture, thank you very much. How can Leads II, aVR and aVL all be isoelectric? I understood that an isoelectric tracing occurs when the predominant electrical vector is perpendicular to the lead so if II and aVR are isoelectric then aVL aVL should be extreme + or – and III should be the opposite of aVL. Sorry for getting off the subject. Thank you again. Amal Mattu April 19, 2015 at 4:48 pm Log in to Reply Replies: David: Remember that the ECG is a 2-dimensional representation of the 3-D structure, so the vector of forces does not always produce a simple left or right , etc. axis. The axis might potentially be left-posterior (I’m just making this up) therefore might be isoelectric in more than 1 or 2 leads. In this case, I don’t have a good representation in my mind about the heart’s shift in position, but remember that a large PE causing RV distension can cause shifting of the heart’s position in the thorax and therefore an unexpected axis. That’s the best that I can explain it. It would be interesting to have a pre-PE CT to compare to a post-PE CT and look exactly at how the heart’s 3-D position in the thorax has shifted, and that might explain the axis change. Rajiv: The UMEM site was taken down. It was run by our university IT personnel, but they had been re-mobilized to focus more on new electronic medical record systems in the hospital (which is actually what they get paid for! the ECG stuff they did for me was volunteer), and so as their time to help with the site diminished, I decided to shift over to this new website which is not run by the university. Anyway, because they don’t run or monitor the site, it closed down. All those cases are still on YouTube, but rest assured that I fully intend to cover all of those topics on the new site in time, and with better quality. With regards the the TWIs in inferior + anteroseptal leads, as I mentioned on the video, this combination is a sign of pulm htn. In the acute, symptomatic patient in whom these findings are new, it’s likely to be PE (the major cause of ACUTE pulm htn.). In a patient in whom these findings are chronic/old, it’s likely to be chronic pulm htn (e.g. COPD or primary pulm htn). I think you’ll find that this combination is otherwise actually not very common. Amal Larry Moore April 20, 2015 at 5:16 am Log in to Reply Aloha Dr. Mattu, Another great case! I had 2 rule outs for this case, 1 being PE, but I also noticed low voltage in the limb leads and what appears to be electrical alternans through the precordials. Any thoughts? -Larry Moore Honolulu, HI Albert Hsu January 6, 2017 at 2:25 am Log in to Reply Dear Dr. Mattu Great cases! but I noticed that in case 2 and 3 , there are inferior + anteroseptal T wave inversion without rightward axis. How does this happen when we assume that it’s large PE under inferior/anteroseptal T wave inversion noted?? Outofsugar February 18, 2018 at 6:19 pm Log in to Reply the video isn’t loading for me 🙁 is it down?? Leave A Comment Cancel replyYou must be logged in to post a comment.