ECG of ischemic heart disease including stable angina,ACD,STEMI ,NSTEMI

1. ECG IN ISCHEMIC HEART
DISEASES.
BY-RICHA SINGH

2. What is Ischemic Heart
Disease?
Ischemic heart disease is a disease caused by decreased
blood flow to the heart muscle, causing a series of
disorders that may end up with the patient's life or cause
different degrees of ventricular dysfunction.
The main cause of ischemic heart disease is the coronary
arteriosclerosis, which causes acute and chronic
narrowing of the coronary arteries, with the consequent
oxygen deficiency in the myocardium.

3. ECG of Ischemic Heart Disease –
 The electrocardiogram is, along with the clinic, one of the main tools for the
diagnosis of ischemic heart disease.
 In both acute events such as chronic, the electrocardiogram we facilitates the
diagnosis, showing us changes, especially in the ST segment and T wave.
 Therefore, when ischemic heart disease is suspected, a 12-lead
electrocardiogram must be done.
 Changes in the ST segment and T wave in the EKG during a stress test, allows
us the diagnosis of angina and the risk stratification.

5. Myocardial infarction-
(MI) is the irreversible damage and death of myocardial muscles cells from the sudden blockage of
a coronary artery by a blood clots or plaque.
Pathological Q Waves-
A pathological Q wave is a Q wave that is more than 0.04 seconds in duration
and more than 25% of the size of the following R waves in that lead (except for
leads III and aVR). Because pathological Q waves may take hours to develop and
can last for a long time, the presence of new pathological Q waves indicates
acute myocardial infarction but the mere presence of Q waves does not
necessarily mean that a new myocardial infarction is taking place.
ST Segment Changes-
One of the most significant findings of myocardial infarction is the presence of ST
segment elevation. The ST segment is the part of the ECG tracing that starts at
the end of the S wave and ends at the beginning of the T wave. The point where
the end of the Q wave and the ST segment meet is called the J point. If the J point
is greater than 2 mm above the baseline, it is consistent with an ST segment
elevation myocardial infarctio

7. Types of Myocardial Infarction Disease (MI):
There are two types of myocardial infarction (MI). Those are in the following-
1. ST Elevated MI:
In a STEMI, is completely blockage or occultation by the blood clot and as a
result heart muscle being supplied by affected starts to die.
This type of heart attack is more severe. It usually recognized by ECG. ECG
shows that “ST Segment” portion highly elevated. The elevated ST Segment
indicates large amount of heart muscles damage.
2. Non-STEMI:
In a NSTEMI, the artery partially or partly occludes and as a result only a
portion of the heart muscle being supplied blood by the affected artery dies.
In Non-STEMI, does not elevated ST segment in ECG.

8. There are different diagnostic
test for myocardial infarction.
Those are in the following:
 ECG,
 Troponin 1, CK MB,
Myoglobin level increase,
 Lipid profile,
 CBC (Increased WBC),
 CRP.

9. Transmural infarction –
 Involving the entire thickness of the left
ventricular wall from endocardium to epicardium,
usually the anterior free wall and posterior free
wall and septum with extension into the RV wall in
15-30%.
 Isolated infarcts of RV and right atrium are
extremely rare.
Subendocardial infarction –
 Multifocal areas of necrosis confined to the inner
1/3-1/2 of the left ventricular wall.
 These do not show the same evolution of
changes seen in a transmural MI.

11. Acute coronary
syndrome (ACS), is a coronary
artery disease in which there is an
involvement of heart due to
coronary artery/arteries.
Ischemic heart disease is a
condition of diverse antilogies, all
having in common a disturbance of
cardiac function due to an
imbalance between O2 supply and
demand.
Acute coronary syndrome (ACS), are
now classified on the basis of
Echocardiography (ECG) into-
 ST elevation Myocardial
Infraction (STEMI), and
 Non – ST elevation Myocardial
Infraction (NSTEMI)

12. STMI and NSTMI (In General)
 • NSTEMI (Non–ST-segment elevation myocardial infarction)
STEMI (ST-segment elevation myocardial infarction) are
commonly known as heart attack.
 • But they are different from each other in some extent.
NSTEMI account for about 30% and STEMI about 70% of all
heart attack (myocardial infarction).
 • In both cases, patients usually present with similar type of
symptoms such as chest pain, nausea, vomiting,
sweating,breathing difficulty.

13. Diagnosis of NSTEMI vs STEMI :
NSTEMI
• ECG - The diagnosis of a
NSTEMI
is based on a typical history of
chest pain, no ST segment
elevation in ECG ,
STEMI
• ECG - The diagnosis of a STEMI
is
based on a typical history of
chest pain, ST segment
elevation in ECG,

14. Treatment of NSTEMI vs STEMI :
1. Antiplatelets (Aspirin, Clopidogrel, Ticagrelor),
2. anticoagulants (Enoxaparin, Dalteparin,
Fondaparinux),
3. beta-blockers (atenolol, metoprolol, bisoprolol),
4. nitrates (isosorbide dinitrate, glyceryl trinitrate),
5. Statins (atorvastatin, rosuvastatin, simvastatin,
pitavastatin),
6. ACE inhibitors (ramipril, enalapril, captopril,
lisinopril) or
7. ARBs (valsartan, candesartan, losartan,
olmesartan), are given
both in NSTEMI and STEMI.

15. Stable angina is when a person has
brief episodes of pain, squeezing, pressure, or
tightness in the chest. It is often a symptom of
coronary heart disease.
A person with stable angina usually has something
blocking their arteries or making it difficult for fresh
blood to flow through them and into the heart. The
lack of blood flow to the heart, called ischemia, is
what causes the pain.

16. A person with stable angina may have episodes of
pain that are brought on by physical exertion or
stress. Episodes are generally short and then
disappear.
There are a few different causes of stable angina,
and symptoms may vary. Stable angina is sometimes
called angina pectoris.
The pain from angina may be an indicator or
warning sign of a heart attack.

19. Take a good care of your body its the only place you have
to live.