This document contains information about electrocardiogram (ECG) patterns and interpretations, including what normal and abnormal findings represent, thresholds for defining abnormalities, and how different ECG findings correlate to specific coronary artery lesions and regions of the heart. It also provides guidelines for the management of unstable angina/non-ST-elevation myocardial infarction (UNSTEMI) and ST-elevation myocardial infarction (STEMI), including recommendations for medications, fibrinolytic therapy, and percutaneous coronary intervention (PCI).

1. Francisco J. Chacón-Lozsán
MD student UCLA-Venezuela
European Society of Cardiology:
Acute Cardiovascular Care Association
LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco
2013

8. Normal
Ischemia—Tall T Wave or inverted (infarction),
ST segment depressed (angina)
Damage— elevated ST segment, T wave inverted.
Infraction (Acute)—Pathologic Q wave,
elevated ST segment and T wave inverted.
Infarction (previous)—Pathologic Q wave,
ST-T can be normal.

9. J Point
In 2 contiguous leads must have:
≥ 0,25 mV in males <40 years old.
≥ 0,2 mV in males >40 years old.
≥ 0,15 mV females in leads V2-V3
≥ 0,1 mV other leads (in absence of left ventricular hypertrophy or LBBB)

10. Ischemia
Q wave
Ischemia Q wave must have:
More of 0,04sec of duration.
More of 25% or R wave of amplitude.

11. Derivation
Affected Region
Coronary Lesion
V1, V2, V3
Antero-Septal
Anterior
Descendent
V3, V4
Anterior
Anterior
Descendent
V5, V6
Lower Lateral
Circumflex, Right
Coronary
DI, aVL
Upper Lateral
Diagonal,
Circumflex
DII, DIII, aVF
Inferior
Right Coronary,
Circumflex
I lateral
II Inferior
III inferior
aVR
aVL lateral
aVF inferior
V1 septal
V2 septal
V3 anterior
V4 anterior
V5 lateral
V6 lateral

12. subendocardyum
subepicardyum

13. Hours
Days

14. UNSTEMI’s Management
Relieve angina using Nitrates.
Patients using BB must continues using it if not Killip class >III
Use BB in pateints with EF preserved.
Calcium channel blockers are indicated in patients with nitrates and BB to
relief symptoms.
Use double antiplatelet theraphy:
• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned
Heparin 70U/Kg EV + Atorvastatin 80mg.
• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned
Heparin 60U/kg EV + Atorvastatin 80mg.
Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.
If not: streptokinase: 1500.000U EV in 1hr.

16. A, indicates appropriate; CTO, chronic total occlusion; I, inappropriate; Int., intervention; Med., medical; Prox.
LAD, proximal left anterior descending artery; Rx, treatment; U, uncertain; and vz., vessel

17. STEMI’s Management
Star the chronometer.
Calm pain: consider Opioids.
Reduce anxiety: consider Tranquilizer in very anxious patients.
Use oxygen in patients with SaO2<95%, breathlessness or with acute heart
failure.
Use double antiplatelet theraphy:
• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned
Heparin 70U/Kg EV + Atorvastatin 80mg.
• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned
Heparin 60U/kg EV + Atorvastatin 80mg.
Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.
If not: streptokinase: 1500.000U EV in 1hr.