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16 ischemia injury & infarct3


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16 ischemia injury & infarct3

  1. 1. 12-LeadElectrocardiography a comprehensive course ia, Is chem I nju ry, & Inf arct Par t 3) ( Adam Thompson, EMT-P, A.S.
  2. 2. Reciprocal Changes Site Facing Reciprocal• ST-Depression found in leads opposite Septal V1, V2 V7, V8, V9 ofAnterior with ST-Elevation is considered those V3, V4 None toLateral reciprocal change. be a I, aVL, V5, V6 II, III, aVF – This is caused by III, view from the opposite a aVF Inferior II, I, aVL direction. Posterior V7, V8, V9 V1, V2
  3. 3. Reciprocal ChangesReciprocal ST-Depression Inferior Injury
  4. 4. Location of MI Septal Anterior Wall Lateral WallInferior Wall
  5. 5. Location of MI Left VentricleRight Ventricle
  6. 6. Antero-Septal Wall• Leads V1 & V2 view the septal wall• Leads V3 & V4 view the anterior wall LV V6 RV V5 V4 V1 V3 V2
  7. 7. Septal Wall
  8. 8. Anterior Wall• Leads V3 & V4 view the Anterior Wall LV V6 RV V5 V4 V1 V3 V2
  9. 9. Anterior Wall
  10. 10. Lateral Wall• Leads I, aVL, V5 & V6 view the lateral wall LV V6 RV V5 V4 V1 V3 V2
  11. 11. Lateral Wall
  12. 12. Inferior WallInferior Wall
  13. 13. Inferior Wall
  14. 14. Inferior Wall
  15. 15. Right Ventricular Wall• With a proximal occlusion of the RCA, a right ventricular infarct is possible. – Hypotension is most common finding. – Right-sided placement of V3 & V4 can be used to view the right ventricle for ST-Elevation. • V4R is most sensitive lead for right-sided changes. • QRS complexes and ST-Elevation may be of much lesser amplitude in right-sided leads.
  16. 16. Right Ventricular Wall• Hypotension is most common assessment finding with RV-Infarction. – NTG should be used very conservatively – Fluids should be administered if unstable• ST-Elevation in lead III > than STE in lead II is very specific for RV-Infarction
  17. 17. Right Ventricular Wall Move V3 & V4 to mirrored position on right side of chest to obtain V3R & V3 V4R.V4 The same can be done for V5 & V6.
  18. 18. Right Ventricular Wall I aVR V1 V4RAlways make II aVL V2 V5sure to denotethe leads you III aVF V3R V6change.
  19. 19. Posterior Wall• Dominant RCA – When the RCA supplies the posterior descending coronary artery – 85% of people have dominant RCA• Dominant Circumflex – When LCx supplies the posterior descending coronary artery – 15% of people have dominant circumflex
  20. 20. Posterior Wall• The reciprocal leads are V1 & V2• ST-depression in V1 & V2 may actually be representing ST-elevation of the posterior wall• Tall R-waves in V1 & V2 may actually be representing pathological Q-waves of the posterior wall
  21. 21. Posterior WallV1/V2 To identify a posterior wall MI, a technique commonly taught is to pretend you are looking at the complex upside-down through a mirror
  22. 22. Posterior Wall V7, V8, V9 I aVR V1 V7 II aVL V2 V8 III aVF V3 V9Move V4 to V7 - posterior axillary lineMove V5 to V8 - midscapularMove V6 to V9 paraspinal
  23. 23. Other MI Findings• If ECG print out does not read ***Acute MI***, it is highly unlikely that the capture meets STEMI criteria. – It is possible that the 12-lead is not a true STEMI even with the “Acute AMI” reading.• Wellen’s phenomenon - Biphasic or inverted T-waves (Most commonly in V2 & V3), precursor to AMI from LAD stenosis.
  24. 24. Part 3• Next we will look at some examples…