Recommended
More Related Content
What's hot
What's hot (20)
Similar to Ekg myocardial ischemia & Infarction
Similar to Ekg myocardial ischemia & Infarction (20)
More from Dr.Vinod Sharma
Recently uploaded
Recently uploaded (20)
Ekg myocardial ischemia & Infarction
- 1. Title ????? Dr. Vinod Sharma National Heart Institute New Delhi 1
- 2. 2
- 3. 3
- 4. 4
- 5. 5
- 6. 6
- 7. 7
- 8. 8
- 9. 9
- 10. 10
- 11. 11
- 12. 12
- 14. 14
- 15. 15
- 16. 16
- 17. 17
- 18. 18
- 19. 19
- 20. 20
- 21. 21
- 22. 22
- 23. 23
- 24. 24
- 26. 26
- 29. 29
- 31. 31
- 32. 32
- 33. 33
- 34. 34
- 35. 35
- 36. 36
- 37. 37
- 40. 40
- 41. 41
- 42. 42
- 43. Pathologic Q wave Criteria “Classic” criteria • Q-wave with a duration ≥40 ms and/or a depth ≥25% of the R-wave in the same lead or the presence of a Q-wave equivalent 43
- 44. 44
- 46. 46
- 47. Anterior MI Pattern - Tombstoning 47
- 48. Tombstoning in Lead V2 – Septal involvement 48
- 49. 49
- 51. 51
- 52. 52
- 54. 54
- 57. 57
- 59. 59
- 61. 61
- 62. 62
- 64. Value of Lead V4R in Acute Inferior MI Lead V4R identifies:- • The coronary artery occluded • Presence or absence of right ventricular infarction. • Those at risk for atrioventricular (AV) block • Those who will profit most from thrombolytic therapy 64
- 65. 65
- 66. 66
- 67. 67
- 68. 68
- 69. 69
- 70. 70
- 71. 71
- 72. 72
- 74. 74
- 75. 75
- 76. 76
- 79. LMCA Occlusion Overview Typical ECG findings with left main coronary artery (LMCA) occlusion: • Widespread horizontal ST depression, most prominent in leads I, II and V4-6 • ST elevation in aVR ≥ 1mm • ST elevation in aVR ≥ V1 79
- 80. ST elevation in aVR 80
- 81. De Winter’s T Waves Clinical Significance of De Winter’s T Waves • The de Winter ECG pattern is an anterior STEMI equivalent that presents without obvious ST segment elevation. • Key diagnostic features include ST depression and peaked T waves in the precordial leads. • The de Winter pattern is seen in ~2% of acute LAD occlusions and is under-recognised by clinicians. 81
- 82. De Winter’s T Waves 82
- 83. De Winter’s T Waves Diagnostic Criteria • Tall, prominent, symmetric T waves in the precordial leads • Up sloping ST segment depression >1mm at the J-point in the precordial leads • Absence of ST elevation in the precordial leads • ST segment elevation (0.5mm-1mm) in aVR • “Normal” STEMI morphology may precede or follow the deWinter pattern Original reports of the de Winter pattern suggested that the ECG did not change or evolve until the culprit artery had been opened. Since then, cases have been reported where the deWinter pattern evolved from, or evolved to a “classic” anterior STEMI. 83
- 84. De Winter’s T Waves 84
- 85. De Winter’s T waves • Upsloping ST depression in the precordial leads (> 1mm at J-point). • Peaked anterior T waves (V2-6), with the ascending limb of the T wave commencing below the isoelectric baseline. • Subtle ST elevation in aVR > 0.5mm. There is also some high lateral involvement, with subtle ST elevation in aVL plus reciprocal change in III + aVF. This is consistent with LAD occlusion occurring proximal to the 1st diagonal. 85
- 86. De Winter’s T waves 86
- 87. De Winter’s T waves 87
- 88. 88
- 89. 89
- 90. 90
- 91. Acute MI with a RBBB 91
- 92. Acute MI with a RBBB 92
- 98. Anterior MI – Isolated J point Elevation 98