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10 ste-mimics part1


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10 ste-mimics part1

  1. 1. 12-LeadElectrocardiography a comprehensive course -Mi mics STE Pa rt 1 Adam Thompson, EMT-P, A.S.
  2. 2. The 6-Step Method• 1. Rate & Rhythm• 2. Axis Determination• 3. Intervals• 4. Morphology• 5. STE-Mimics• 6. Ischemia, Injury, & Infarct
  3. 3. What is a STEMI?• STEMI = ST-Elevated Myocardial Infarction• Its how we “diagnose” someone with an MI in the field and activate a “STEMI Alert” ST-Segment
  4. 4. STE-Mimics Lessons• STE-Mimics – Any cause of ST-Elevation or AMI-like patterns that is not associated with an actual MI.
  5. 5. Objectives• Learn what the different STE-Mimics are.• Learn how to identify a STE-Mimic.• Learn how to differentiate between a STE- Mimic and a STEMI – (ST-Segment Elevation Myocardial Infarction)
  6. 6. ST-Elevation• The most common cause of ST- elevation is not myocardial infarction.• Less than 50% of STEMI alerts called by paramedics are actually ACS patients
  7. 7. ST-Elevation TP-Segment• ST-Elevation is elevation of the J-Point which causes elevation of the following ST- Segment.• Elevation is defined as anything above the T P isoelectric line.• Find the isoelectric line by locating the TP- Segment.
  8. 8. ST-Elevation• The J-Point is where the QRS complex J-Point and the ST-Segment meet.
  9. 9. Causes of ST-Elevation Listed from most common to least: • Left ventricular hypertrophy (LVH) • Left bundle branch block (LBBB) • Benign early repolarization (BER) • Right bundle branch block (RBBB) • Nonspecific BBB • Ventricular Aneurysm • Pericarditis • Undefined or unknown cause
  10. 10. Causes of ST-Elevation Easier way to remember: E - Electrolytes (hyperkalemia) L - LBBB E - Early repolarization V - Ventricular hypertrophy (LVH) A - Aneurysm T - Treatment (e.i. pericardiocentesis) I - Injury (AMI, contusion) O - Osborne waves (hypothermia) N - Non-occlusive vasospasm
  11. 11. Lead Placement • Poor ECG captures were noted as a common problem. • V3 is most commonly misplaced lead
  12. 12. What are Contiguous Leads?Lead I aVR V1 V4 • Contiguous leads are leads that look at high lateral septal anterior the same area of the heart.Lead II aVL V2 V5 •inferior show up on the 12-lead proximal They high lateral septal low lateral to each other.Lead III aVF V3 V6 inferior inferior anterior low lateral
  13. 13. Reciprocal Changes Site Facing Reciprocal Septal V1, V2 None• Reciprocal changesV4 changes like Anterior V3, are None ST-depression I, aVL, V5, V6 Lateral or T-Wave inversion in II, III, aVF leads opposite to the site of injury. Inferior II, III, aVF I, aVL Posterior V7, V8, V9 V1, V2, V3, V4
  14. 14. Left Ventricular Hypertrophy• The “Strain Pattern” is a repolarization abnormality associated with LVH and may cause ST-Segment changes.• STEMI is more difficult, but still possible to identify in the presence of LVH.
  15. 15. LV Strain Pattern Left Precordial Leads Right Precordial Leads V4, V5, V6 V1, V2, V3Normal Complex
  16. 16. LV Strain• Discordance means opposite. – T-Wave discordance means that the T- Wave is deflected in the opposite direction as the terminal (last) wave of the QRS. – T-Wave discordance is normal in every lead with Left or Right BBBs.
  17. 17. LVH Clues• T wave Discordance (widened QRS/T angle)• Concave ST-Segments with asymmetrical T waves• The height of STE and T waves are directly proportionate to the depth of the S waves. – The taller the R wave the deeper the ST depression.• STE in right precordial leads with depression in left precordial leads due to “strain pattern”.
  18. 18. LV-Strain
  19. 19. LV-Strain
  20. 20. LV-Strain
  21. 21. LV-Strain
  22. 22. The End• More in the next lesson