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Action potential
“AP”
Electrocardiograph
“ECG”
Hamad Emad Dhuhayr
CONTENTS
1. SOEPEL
2. AP
3. ECG
SUBJECT:
Presenting Complaint
An 81 year-old Saudi male is admitting to hospital with worsening abdominal pain over
the la...
OBJECTIVE:
taking history, physical examination
VITAL SIGNS:
*Physical Examination
38.8 C
RR: 16/min
78 bpm
210/100 mm/Hg
...
EVALUATION (DD):
Myocardiac infraction
Appendicitis
Peptic ulcer
PLAN: ECG , ckmp and troponin *i-t* blood test.
ELABORATI...
LEARNING GOALS:
AP - ECG
SOEPEL
AP
Localization - Myocardial Infarct
Localization ST elevation
Reciprocal
ST depression
Coronary Artery
Anterior MI V1-V6 Non...
AnteriorWall
V3,
V4
• Left anterior chest
• Positive electrode
on anterior chest
12
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6...
Septal Wall
 V1, V2
◦ Along sternal borders
◦ Look through right ventricle & see
septal wall
I
II
III
aVR
aVL
aVF
V1
V2
V...
Practice
14
Anteroseptal MI
ST elevations V1, V2, V3, V4 24-May-
14January 2004
15
Lateral Wall
 I and aVL
◦ View from Left Arm 
◦ lateral wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6...
Lateral Wall
 V5 and V6
◦ Left lateral chest
◦ lateral wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
1624...
LateralWall
• I, aVL,V5,V6
• ST elevation suspect lateral wall injury
17
Lateral Wall
24-May-14
Lateral MI
1824-May-14
19
Inferior Wall
 II, III, aVF
◦ View from Left Leg 
◦ inferior wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
...
Inferior MI
2024-May-14
Posterior Leads
• Posterior leadsV1,V2
• Posterior Infarct with ST
Depressions and/ tall R wave
• RCA and/or LCXArtery
ST ...
24-May-14Dr. UZMA ANSARI 22
ECG 1.The ECG above belongs to a patient with stable angina pectoris.The patient complained of effort angina
in the last 2...
ECG
ECG
ECG
ECG
ECG
ECG
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ECG

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Transcript of "ECG"

  1. 1. Action potential “AP” Electrocardiograph “ECG” Hamad Emad Dhuhayr
  2. 2. CONTENTS 1. SOEPEL 2. AP 3. ECG
  3. 3. SUBJECT: Presenting Complaint An 81 year-old Saudi male is admitting to hospital with worsening abdominal pain over the last 2-3 days. There is no chest pain or dsyponea (shortness of breath), however she complains of nausea and vomiting. Past Medical History On examination of the patient's history it appears that he has a history of hypertension,Type 2 Diabetes mellitus (formerly NIDDM), coronary artery disease status post myocardial infarction (CAD S/P MI) 5 years ago and chronic abdominal pain for the last 2 years without a clear reason. SOEPEL
  4. 4. OBJECTIVE: taking history, physical examination VITAL SIGNS: *Physical Examination 38.8 C RR: 16/min 78 bpm 210/100 mm/Hg SOEPEL
  5. 5. EVALUATION (DD): Myocardiac infraction Appendicitis Peptic ulcer PLAN: ECG , ckmp and troponin *i-t* blood test. ELABORATION: surgical intervention SOEPEL
  6. 6. LEARNING GOALS: AP - ECG SOEPEL
  7. 7. AP
  8. 8. Localization - Myocardial Infarct Localization ST elevation Reciprocal ST depression Coronary Artery Anterior MI V1-V6 None LAD Septal Mi V1-V4, disappearance of septumQ in leads V5,V6 none LAD Lateral MI I, aVL,V5,V6 II,III, aVF (inferior leads) LCX Inferior MI II, III, aVF I, aVL (lateral lead) RCA (80%) or LCX (20%) Posterior MI V7,V8,V9 high R inV1-V3 with ST depressionV1-V3 > 2mm (mirror view) RCA or LCX RightVentricle MI V1,V4R I, aVL RCA Atrial MI PTa in I,V5,V6 PTa in I,II, or III RCA 11 The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG).
  9. 9. AnteriorWall V3, V4 • Left anterior chest • Positive electrode on anterior chest 12 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May-14
  10. 10. Septal Wall  V1, V2 ◦ Along sternal borders ◦ Look through right ventricle & see septal wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 1324-May-14
  11. 11. Practice 14 Anteroseptal MI ST elevations V1, V2, V3, V4 24-May- 14January 2004
  12. 12. 15 Lateral Wall  I and aVL ◦ View from Left Arm  ◦ lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May- 14January 2004
  13. 13. Lateral Wall  V5 and V6 ◦ Left lateral chest ◦ lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 1624-May-14
  14. 14. LateralWall • I, aVL,V5,V6 • ST elevation suspect lateral wall injury 17 Lateral Wall 24-May-14
  15. 15. Lateral MI 1824-May-14
  16. 16. 19 Inferior Wall  II, III, aVF ◦ View from Left Leg  ◦ inferior wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May-14
  17. 17. Inferior MI 2024-May-14
  18. 18. Posterior Leads • Posterior leadsV1,V2 • Posterior Infarct with ST Depressions and/ tall R wave • RCA and/or LCXArtery ST elevation inV7,V8,V9. • Understand Reciprocal changes • The posterior aspect of the heart is viewed as a mirror image and therefore depressions versus elevations indicate MI • Rarely by itself usually in combo. Dr. UZMA ANSARI 21 24-May- 14January 2004
  19. 19. 24-May-14Dr. UZMA ANSARI 22
  20. 20. ECG 1.The ECG above belongs to a patient with stable angina pectoris.The patient complained of effort angina in the last 2 weeks. Coronary angiography was performed and then the patient was referred to coronary artery bypass graft operation because of 3 vessel disease. ST segment flattening is one of the first signs of coronary ischemia and generally preceedes ST segment depression.
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