"strain" on EKG

[lightthelamp4]

Hey guys,
Fourth year student here, I was just wondering if someone could clarify something that has been nagging at me for a while and I have not been able to find a clear answer for. When discussing EKG's and using the term "strain", what exactly does this mean? I know that this is very relevant especially with our PE patients when we are evaluating for right heart strain, and patients with LVH when we are considering ACS. I am watching Dr Amal Mattu's EKG course and he states that the term strain can refer to ST depression/inversion/T wave inversions or QRS widening. I have heard other things from residents/attendings and just would like to make sure I am thinking about it the right way. Thank you for any help !

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[lightthelamp4]

also, strain = secondary repolarization abnormality?

 

[shoal]

Let me take a stab. Strain refers to the heart working extra hard. As stated, st depression with t-wave inversion in the lateral precordial leads in the setting of lvh voltage criteria would be lvh with strain. As for right sided strain, i believe this more refers to rightward axis, classic s1 q3 t3 morphology and could also be either inferior or right sided precordial leads v1 to v3 with rvh and st and t wave inversion. As for qrs widening this is above my current knowledge level and will require some indepth reading. Look forward to this thread.

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[SuckySurgeon7]

I can't answer the question better, but just wanted to agree with OP that Amal Mattu rocks for presenting basic and advanced EKG stuff. Also looking forward to this thread!

 

[lightthelamp4]

thanks guys

I was hoping that others would be in same boat as me lol

 

[WalkingCorpse]

Check out the "Life in the fast lane" blog. They have a lot of good quick hitter EKG explanations on there.

 

[Birdstrike]

Hey guys,
Fourth year student here, I was just wondering if someone could clarify something that has been nagging at me for a while and I have not been able to find a clear answer for. When discussing EKG's and using the term "strain", what exactly does this mean? I know that this is very relevant especially with our PE patients when we are evaluating for right heart strain, and patients with LVH when we are considering ACS. I am watching Dr Amal Mattu's EKG course and he states that the term strain can refer to ST depression/inversion/T wave inversions or QRS widening. I have heard other things from residents/attendings and just would like to make sure I am thinking about it the right way. Thank you for any help !

If you're going over lectures by Amal Mattu, definitely go by what he says, over anything I say. He knows more about ekg's than me.

That being said, I'll bite. I think at the medical student stage, and for the purposes of EM, if you know S1Q3T3, you're par for the course. Otherwise, digging too deep and trying to pinpoint which chronic lung, valve and/or right ventricular condition might be causing right-heart strain EKG findings, may not be that helpful. If it points you to possible PE, that's helpful.

Otherwise, if you see ST/T-wave changes in the right sided leads, in the setting of an acute cardiac or pulmonary complaint, just know that you need to work the patient up, possibly for PE, ACS, etc, depending on the clinical scenario.

Other than S1Q3T3, you're basically talking about non-specific EKG changes localizing to the right sided heart leads. Could be acute. Could be chronic. Get an old ekg to compare, and work it up.

 

[deleted547339]

If you're going over lectures by Amal Mattu, definitely go by what he says, over anything I say. He knows way more about ekg's than me.

Other attendings, correct me if I'm wrong, But I think at the medical student stage, and for the purposes of EM, if you know S1Q3T3, you're par for the course. Otherwise, digging too deep and trying to pinpoint which chronic lung, valve and/or right ventricular condition might be causing right-heart strain EKG findings, may not be that helpful. If it points you to possible PE, that's helpful.

Otherwise, if you see ST/T-wave changes in the right sided leads, in the setting of an acute cardiac or pulmonary complaint, just know that you need to work the patient up, possibly for PE, ACS, etc, depending on the clinical scenario.

Other than S1Q3T3, you're basically talking about non-specific EKG changes localizing to the right sided heart leads. Could be acute. Could be chronic. Get an old ekg to compare, and work it up.

Additionally, Amal Mattu says that TWI in inf and precordial leads is PE until proven otherwise.