ecg: interpreting asmi
Post on 25-Jun-2015
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PROF DR.MAGESHKUMAR’S UNITDR.S.GEETHALAKSHMI
35 Yr old MR. JAYAKUMAR Came with
• c/o retrosternal compressing chest pain• 2 hrs duration , Radiating to left arm• Associated diaphoresis & palpitations +nt• Smoker 15 yrs• Alcoholic 10 yrs• Not a k/c/o SHT / DM / CAD pt• Examn fairly normal• Vitals stable with a BP of 140 / 90 mm Hg
I
II
III
SHOWS
• RATE 100/min• RHYTHM normal sinus rhythm• P WAVE present with normal morphology• PR INTERVAL 0.16 secs• QRS DURATION normal• QT INTERVAL 0.32 secs• ST SEGMENT ELEVATION V1 – V4
DIAGNOSIS• ANTERIOR WALL MI
what more from what more from ecg ?ecg ?
• Localize CULPRIT CORONARY VESSELTo assess the size of ischemic area To be prepared for EXPECTED COMPLICATIONS• PROGNOSIS – ST segment score(> 15 )• Grading of ischaemia I – tall peaked symmetric R waves ii – ST elevation iii – distortion of terminal QRS
CORONARY VASCULAR ANATOMY
Sites of occlusionProximal l a d
Septal
Diagonal
Distal l a d
ECG CHANGES LOOK AT
PROXIMAL L A D
MID L A D
DISTAL L A D
V 1-4 ST ST ST
II , III , AVF ST ST (III esp.)
ST isoelectric or
AVR ,
ST ST ST
V 5 , 6 ST
AVL ST
CONDUCTION DEFECTS
RBBBLAFB
PROXIMAL L A D OCCLUSION
PROXIMAL L A D
ST ELEVATION AVR
ST DEPRESSION IN INFERIOR LEADS , V5,6
DISTAL L A D OCCLUSION
DISTAL L A D
ST DEPRESSION AVR
ST ISOELECTRIC OR ELEVATED IN INFERIOR LEADS
PROXIMAL TO SEPTAL BR.
PROXIMAL TO SEPTAL BR.
ST ELEVATED IN INFERIOR LEADS (ESP III) & AVR
ST DEPRESSED IN AVL
COMPLICATIONS
Involvement of the distal AV conduction right bundle branch block (RBBB) Left fascicular block, Heart failure and Ventricular tachycardia and fibrillation <subacute phase>
To summarize……..
A SIMPLE CARRY HOME MESSAGE ASMI ST elevation in V 1-4 reciprocal ST depression in ii ,iii , aVF
Present absent DISTAL L A D
ST elevation in V1 , a VR
Present absent ST elevation avr > V1
+ RBBB , LAFB PROXIMAL MID L A D LT MAIN BR.
DISTAL TO SEPTAL BR.
DISTAL TO SEPTAL
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