12 lead electrocardiogram (ecg) pfn: somacl17
TRANSCRIPT
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Slide 1JSOMTC, SWMG(A)
12 Lead Electrocardiogram (ECG) PFN: SOMACL17
Slide 2JSOMTC, SWMG(A)
Terminal Learning Objective
Action: Communicate knowledge of 12 Lead Electrocardiogram (ECG)
Condition: Given a lecture in a classroom environment
Standard: Received a minimum score of 84% on the written exam IAW course AHA standards
Slide 3JSOMTC, SWMG(A)
References
Advanced Cardiovascular Life Support, Provider Manual 2010
The 12 lead ECG in Acute Myocardial Infarction 1996
The 12 lead ECG for Acute and Critical Care Providers 2005
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Slide 4JSOMTC, SWMG(A)
Reason
Ischemic heart disease causes the greatest number of deaths in the United States.
50% die before arriving at a hospital.
If treatment is not received within 2 hours of onset of symptoms, chance of survival is 25%.
By treating a heart attack within one hour of onset of symptoms, the chance of survival is 49%!
Slide 5JSOMTC, SWMG(A)
Reason
The keys to quick management of an acute myocardial infarction (AMI) patient are:
Prompt recognition of the symptoms
Rapid performance and interpretation of a 12 Lead ECG
Provide pre‐arrival notification to the receiving facility
Slide 6JSOMTC, SWMG(A)
Agenda
Recall the pathophysiology of acute myocardial infarction (AMI)
Identify the electrode placement for a 12 Lead ECG
Identify the 12 Lead ECG physiology to assess an AMI
Identify an AMI using a 12 Lead ECG
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Slide 7JSOMTC, SWMG(A)
Agenda
Identify the limitations and complications of recognizing an AMI using a 12 Lead ECG
Participate in a 12 Lead ECG interpretation practical exercise
Slide 8JSOMTC, SWMG(A)
Pathophysiology of Acute Myocardial Infarction (AMI)
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Pathophysiology of AMI
A heart attack occurs when a thrombus or blood clot forms in a coronary artery, cutting off the blood supply to a segment of the heart muscle.
Prompt restoration of blood flow can stop and minimize (or even prevent) the heart damage.
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Slide 10JSOMTC, SWMG(A)
Pathophysiology of AMI
The blood flow can be restored by:
Percutaneous coronary intervention (PCI)
Coronary artery bypass graft (CABG)
Administration of a clot dissolving (thrombolytic) drug
Slide 11JSOMTC, SWMG(A)
Pathophysiology of AMI
ACS symptom review:
Crushing chest pain lasting more than 15 minutes
Chest Pain spreading to the shoulders, neck, arms or jaw
Chest discomfort with lightheadedness, fainting, sweating or nausea
Shortness of breath with or without chest discomfort
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Electrode Placement for a 12 Lead ECG
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ECG Leads
Bipolar
Leads I, II, and III
Unipolar
Leads aVR, aVL, and aVF
Precordial
V1, V2, V3, V4, V5, and V6
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12 Lead ECG Preparation
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Bipolar and Unipolar Leads
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Precordial Leads
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V1
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V2
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V4
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V3
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V5
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V6
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12 Lead ECG Electrode Placement
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12 Lead ECG Physiology to Assess an AMI
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12 Lead ECG Relationship to Coronary Artery Anatomy
Let’s look at the heart
Page 28 in the ACLS Handbook
The right coronary artery (RCA) supplies oxygen to the inferior (bottom) surface of the heart
Slide 26JSOMTC, SWMG(A)
12 Lead ECG Relationship to Coronary Artery Anatomy
The left coronary artery (LCA) splits in two:
The left anterior descending coronary artery (LAD)
The left circumflex coronary artery (LCX or Cx)
Slide 27JSOMTC, SWMG(A)
12 Lead ECG Relationship to Coronary Artery Anatomy (cont)
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Slide 28JSOMTC, SWMG(A)
12 Lead ECG Relationship to Coronary Artery Anatomy
The left anterior descending coronary artery (LAD) courses down the anterior (front) surface of the heart and supplies oxygen to the septal, anterior, and lateral sides of the heart.
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12 Lead ECG Relationship to Coronary Artery Anatomy (cont)
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12 Lead ECG Relationship to Coronary Artery Anatomy
The left circumflex coronary artery (Cx) supplies oxygen to the left lateral (side) surface of the heart.
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12 Lead ECG Relationship to Coronary Artery Anatomy (cont)
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12 Lead ECG Relationship to Coronary Artery Anatomy
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12 Lead ECG Relationship to Coronary Artery Anatomy (cont)
aVF inferiorIII inferior V3 anterior V6 lateral
aVL lateralII inferior V2 septal V5 lateral
aVRI lateral V1 septal V4 anterior
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12 Lead ECG Relationship to Coronary Artery Anatomy
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Identify an AMI Using a 12 Lead ECG
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Analyze the 12 Lead ECG
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Normal 12 Lead ECG
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12 Lead Versus 3 Lead ECG
Differences
2.5 second views instead of a 6 second view
Legend
Views mimic anatomy of the heart
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Identify an AMI
Baseline
Ischemia—tall or inverted T wave (infarct),ST segment may be depressed (angina)
Injury—elevated ST segment, T wave may invert
Infarction (Acute)—abnormal Q wave,ST segment may be elevated and T wavemay be inverted
Infarction (Age Unknown)—abnormal Q wave,ST segment and T wave returned to normal
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Slide 40JSOMTC, SWMG(A)
ECG Recording
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Identify an AMI
Know what to look for: Measure from J point
ST elevation or depression >1 mm
2 anatomical leads
Pathologic Q wave greater than 40 ms or greater than 1/3 height of R wave PR baseline
ST‐segment deviation= 4.5 mm
J point plus0.04 second
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ST Segment Elevation Myocardial Infarctions (STEMIs)
Acute Anterior Wall Infarct
Anterolateral Infarct
Acute Inferior Wall Infarct
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Acute Anterior Wall Infarct
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Anterolateral Infarct
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Acute Inferior Wall Infarct
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Limitations and Complications of Recognizing an AMI Using a
12 Lead ECG
Slide 47JSOMTC, SWMG(A)
Limitations of 12 Lead ECG
12 Lead ECG:
Does not look at the right ventricle of the heart
• Acute Right Ventricular Infarct
Does not look at the posterior (rear) of the heart
• Posterior Wall Infarct
Patient can still be having an AMI even if ST elevation is not seen on a 12 lead ECG
Slide 48JSOMTC, SWMG(A)
Right Ventricular Infarct
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Slide 49JSOMTC, SWMG(A)
Right Ventricular Infarct
Looks just like an inferior infarct
Take lead V4 and place it 5th ICS MCL on the right side of the chest
RVI suspected if ST elevation is present in that lead
Usually this patient is in cardiogenic shock due to a heavy reliance on preload
Don’t administer Nitro or Morphine
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Posterior Wall Infarct
Slide 51JSOMTC, SWMG(A)
Posterior Wall Infarct
ST segment depression is reciprocal of ST segment elevation
Taller R wave is reciprocal of pathological Q wave
Usually noticed in leads V1, V2, and V3
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Slide 52JSOMTC, SWMG(A)
Complications of 12 Lead ECG
AMI can affect the conduction system of the heart
New Left Bundle Branch Block
Lethal Dysrhythmias
Examples: VF or Pulseless VT
Cardiogenic Shock
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Left Bundle Branch Block
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Left Bundle Branch Block
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Left Bundle Branch Block
Look at the QS complex in V1
QRS > 0.12 seconds
Pointing down indicates LBBB
Slide 56JSOMTC, SWMG(A)
12 Lead ECG Interpretation Practical Exercise
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Practical Exercise
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Questions?
Slide 59JSOMTC, SWMG(A)
Terminal Learning Objective
Action: Communicate knowledge of 12 Lead Electrocardiogram (ECG)
Condition: Given a lecture in a classroom environment
Standard: Received a minimum score of 84% on the written exam IAW course AHA standards
Slide 60JSOMTC, SWMG(A)
Agenda
Recall the pathophysiology of acute myocardial infarction (AMI)
Identify the electrode placement for a 12 Lead ECG
Identify the 12 Lead ECG physiology to assess an AMI
Identify an AMI using a 12 Lead ECG
21
Slide 61JSOMTC, SWMG(A)
Agenda
Identify the limitations and complications of recognizing an AMI using a 12 Lead ECG
Participate in a 12 Lead ECG interpretation practical exercise
Slide 62JSOMTC, SWMG(A)
Reason
Ischemic heart disease causes the greatest number of deaths in the United States.
50% die before arriving at a hospital.
If treatment is not received within 2 hours of onset of symptoms, chance of survival is 25%.
By treating a heart attack within one hour of onset of symptoms, the chance of survival is 49%!
Slide 63JSOMTC, SWMG(A)
Reason
The keys to quick management of an acute myocardial infarction (AMI) patient are:
Prompt recognition of the symptoms
Rapid performance and interpretation of a 12 Lead ECG
Provide pre‐arrival notification to the receiving facility