I Hate Waiting in Line
So I’m Not Going to Climb Mt. Everest
Look at these climbers cueing up to climb Mt. Everest. I like a nice little hike, but after seeing this, I am not going to climb Everest. I hate waiting in line.
Which reminds me of my aversion to waiting. Camilla and I were married in October 1970. In December that year we were Christmas shopping in downtown Boston in a cheapskate’s paradise, Filene’s Basement (since deceased, like too many of my other friends). I was waiting at the bottom of the escalator where Camilla had said she would meet me before we separated to shop. After I stood for a while, some guy in his 60’s who was standing beside me, looked over, and said something like, “Waiting for your wife, kid? It only gets worse.” That guy was clairvoyant.
The heart also hates to wait…for repolarization. The last post on ECGs (1) discussed how the heart depolarizes from the inside to the outside, giving a positive vector. It repolarizes in the opposite direction, from the outside to the inside, but this also give a positive vector. So, the rule was that the R wave and the T wave are buds and go together in the same direction in just about every lead,.
But if the heart is thickened from enlargement of the muscle from conditions such as hypertension or hypertrophic cardiomyopathy or if there is conduction delay, such as from left bundle branch block, the endocardium gets tired of waiting for repolarization to come from the outside and the endocardium starts to repolarize. This eliminates the electrical neutrality of the normal ST segment and can produce a negative ST segment as well as a negative or biphasic T wave.
The figures demonstrates this. On top is normal depolarization from the last post. Below is what happens with left ventricular hypertrophy. What’s the rule. The R wave and the T wave generally go in the same direction, but when there’s hypertrophy or conduction delay, even the endocardium hates waiting. So, reploarization starts “early” and T wave and R wave may part company.
#cardiac #ECG #electrocardiogram #left ventricular hypertrophy #repolarization
Ah, Filenes Basement. Spent a many times outside the Basement (few men were crazy enough to actually go in the basement) waiting for my girlfriend (now wife for 53 years) to emerge from it in the lates 60s.
It looks like that if you're climbing Diamond Head in Hawaii. My husband and I went first thing in the morning and there wasn't a line - yet. We climbed a mountain to celebrate my heart transplant anniversary. It was the best anniversary I've ever had!