Advanced ECG Interpretations

  Are you treating myocardial infarctions? Why? That's DEAD tissue! You should be treating myocardial ischemia! What's the difference between ST elevation and ST depression? Does ST depression ALWAYS represent a subendocardial ischemia? Does  ST elevation ALWAYS  represent an acute transmural ischemia? Which blood test do you use to confirm an acute transmural ischemia...         ...troponins, or a CK-MB? If you base you diagnosis of an acute transmural ischemia on the presence of ST elevation according to the STEMI protocol, then you are basing your diagnosis on a CK-MB, because that's the test that was used to "prove" that the ST deviation was or was not a STEMI! The STEMI protocol was based on just ONE article that used CK-MB assays as proof of acute transmural ischemia. Is there a problem with that? Well, no... if you don't mind missing about 25% of acute transmural ischemias that should have gone directly to the cath lab but instead were...

                   A Closer Look at Right Bundle Branch Block (RBBB) Jerry W. Jones, MD FACEP FAAEM I once wrote an article about “rabbit ears” and RBBB and posted it on my blog ( https://medicusofhouston.com/dr-joness-ecg-blog/) . To this date it has been the most read article I have produced. So, let’s take a closer look at RBBB.  The  right bundle branch courses down the wall of the interventricular septum on the right ventricular side. Its course is superficial at some points, so it is very susceptible to injury by central venous lines or stretching (dilatation) of the right ventricle. The diagram on the left shows both bundle branches (right – yellow, left – red). With the right bundle branch blocked up high (dotted line), the atrial impulse travels down the left bundle branch into the anterior and posterior fascicles. The left ventricle is depolarized normally and at its usual speed. The first portion of the left vent...