12-LeadElectrocardiography       a comprehensive course              ia,      Is chem      I nju ry, &        Inf arct    ...
Reciprocal Changes     Site           Facing          Reciprocal• ST-Depression found in leads opposite     Septal        ...
Reciprocal ChangesReciprocal ST-Depression     Inferior Injury
Location of MI                    Septal                      Anterior Wall                      Lateral WallInferior Wall
Location of MI         Left VentricleRight Ventricle
Antero-Septal Wall• Leads V1 & V2 view the septal wall• Leads V3 & V4 view the anterior wall                  LV          ...
Septal Wall
Anterior Wall• Leads V3 & V4 view the Anterior Wall                  LV                                      V6           ...
Anterior Wall
Lateral Wall• Leads I, aVL, V5 & V6 view the lateral  wall                  LV                                      V6    ...
Lateral Wall
Inferior WallInferior Wall
Inferior Wall
Inferior Wall
Right Ventricular Wall• With a proximal occlusion of the RCA, a right  ventricular infarct is possible.  – Hypotension is ...
Right Ventricular Wall• Hypotension is most common assessment  finding with RV-Infarction.   – NTG should be used very con...
Right Ventricular Wall               Move V3 & V4 to mirrored               position on right side of               chest ...
Right Ventricular Wall                 I     aVR V1     V4RAlways make      II    aVL   V2   V5sure to denotethe leads you...
Posterior Wall• Dominant RCA  – When the RCA supplies the posterior descending    coronary artery  – 85% of people have do...
Posterior Wall• The reciprocal leads are V1 & V2• ST-depression in V1 & V2 may actually be  representing ST-elevation of t...
Posterior WallV1/V2         To identify a posterior wall MI, a technique         commonly taught is to pretend you are    ...
Posterior Wall                   V7, V8, V9                                   I      aVR V1     V7                        ...
Other MI Findings• If ECG print out does not read ***Acute MI***, it is  highly unlikely that the capture meets STEMI crit...
Part 3• Next we will look at some examples…
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16 ischemia injury & infarct3

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  • The absence of reciprocal changes does not mean the patient is not experiencing an MI. The presence of reciprocal changes, however, is highly indicative of an acute myocardial infarction.
  • The absence of reciprocal changes does not mean the patient is not experiencing an MI. The presence of reciprocal changes, however, is highly indicative of an acute myocardial infarction.
  • Because of the location of the coronary arteries, Septal Mis almost always have anterior extension.
  • 16 ischemia injury & infarct3

    1. 1. 12-LeadElectrocardiography a comprehensive course ia, Is chem I nju ry, & Inf arct Par t 3) ( Adam Thompson, EMT-P, A.S.
    2. 2. Reciprocal Changes Site Facing Reciprocal• ST-Depression found in leads opposite Septal V1, V2 V7, V8, V9 ofAnterior with ST-Elevation is considered those V3, V4 None toLateral reciprocal change. be a I, aVL, V5, V6 II, III, aVF – This is caused by III, view from the opposite a aVF Inferior II, I, aVL direction. Posterior V7, V8, V9 V1, V2
    3. 3. Reciprocal ChangesReciprocal ST-Depression Inferior Injury
    4. 4. Location of MI Septal Anterior Wall Lateral WallInferior Wall
    5. 5. Location of MI Left VentricleRight Ventricle
    6. 6. Antero-Septal Wall• Leads V1 & V2 view the septal wall• Leads V3 & V4 view the anterior wall LV V6 RV V5 V4 V1 V3 V2
    7. 7. Septal Wall
    8. 8. Anterior Wall• Leads V3 & V4 view the Anterior Wall LV V6 RV V5 V4 V1 V3 V2
    9. 9. Anterior Wall
    10. 10. Lateral Wall• Leads I, aVL, V5 & V6 view the lateral wall LV V6 RV V5 V4 V1 V3 V2
    11. 11. Lateral Wall
    12. 12. Inferior WallInferior Wall
    13. 13. Inferior Wall
    14. 14. Inferior Wall
    15. 15. Right Ventricular Wall• With a proximal occlusion of the RCA, a right ventricular infarct is possible. – Hypotension is most common finding. – Right-sided placement of V3 & V4 can be used to view the right ventricle for ST-Elevation. • V4R is most sensitive lead for right-sided changes. • QRS complexes and ST-Elevation may be of much lesser amplitude in right-sided leads.
    16. 16. Right Ventricular Wall• Hypotension is most common assessment finding with RV-Infarction. – NTG should be used very conservatively – Fluids should be administered if unstable• ST-Elevation in lead III > than STE in lead II is very specific for RV-Infarction
    17. 17. Right Ventricular Wall Move V3 & V4 to mirrored position on right side of chest to obtain V3R & V3 V4R.V4 The same can be done for V5 & V6.
    18. 18. Right Ventricular Wall I aVR V1 V4RAlways make II aVL V2 V5sure to denotethe leads you III aVF V3R V6change.
    19. 19. Posterior Wall• Dominant RCA – When the RCA supplies the posterior descending coronary artery – 85% of people have dominant RCA• Dominant Circumflex – When LCx supplies the posterior descending coronary artery – 15% of people have dominant circumflex
    20. 20. Posterior Wall• The reciprocal leads are V1 & V2• ST-depression in V1 & V2 may actually be representing ST-elevation of the posterior wall• Tall R-waves in V1 & V2 may actually be representing pathological Q-waves of the posterior wall
    21. 21. Posterior WallV1/V2 To identify a posterior wall MI, a technique commonly taught is to pretend you are looking at the complex upside-down through a mirror
    22. 22. Posterior Wall V7, V8, V9 I aVR V1 V7 II aVL V2 V8 III aVF V3 V9Move V4 to V7 - posterior axillary lineMove V5 to V8 - midscapularMove V6 to V9 paraspinal
    23. 23. Other MI Findings• If ECG print out does not read ***Acute MI***, it is highly unlikely that the capture meets STEMI criteria. – It is possible that the 12-lead is not a true STEMI even with the “Acute AMI” reading.• Wellen’s phenomenon - Biphasic or inverted T-waves (Most commonly in V2 & V3), precursor to AMI from LAD stenosis.
    24. 24. Part 3• Next we will look at some examples…
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