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[object Object],[object Object]
ECG Rhythm Interpretation Module VI Advanced 12-Lead Interpretation
Course Objectives ,[object Object],[object Object],[object Object]
Learning Modules ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The 12-Lead ECG ,[object Object],[object Object],[object Object],[object Object]
ST Elevation and  non-ST Elevation MIs
ST Elevation and non-ST Elevation MIs ,[object Object],[object Object]
ECG Changes ,[object Object],Appearance of pathologic Q-waves T-waves peaked  flattened  inverted ST elevation & depression
ECG Changes & the Evolving MI ,[object Object],[object Object],[object Object],Non-ST Elevation ST Elevation
ST Elevation Infarction ,[object Object],The ECG changes seen with a ST elevation infarction are: Before injury Normal ECG ST elevation  & appearance of Q-waves  ST segments and T-waves return to normal, but Q-waves persist Ischemia Infarction Fibrosis
ST Elevation Infarction ,[object Object],[object Object],[object Object],[object Object],[object Object],Here’s a diagram depicting an evolving infarction:
ST Elevation Infarction ,[object Object],Here’s an ECG of an  inferior  MI: Question:  What ECG changes do you see? ST elevation and Q-waves Extra credit:  What is the rhythm? Atrial fibrillation (irregularly irregular with narrow QRS)!
Non-ST Elevation Infarction ,[object Object],Here’s an ECG of an  inferior  MI later in time: ST elevation,  Q-waves and  T-wave inversion
Non-ST Elevation Infarction ,[object Object],The ECG changes seen with a non-ST elevation infarction are: Before injury Normal ECG ST depression & T-wave inversion  ST returns to baseline, but T-wave inversion persists Ischemia Infarction Fibrosis
Non-ST Elevation Infarction ,[object Object],Here’s an ECG of an evolving non-ST elevation MI: Question:  What area of the heart is infarcting? Anterolateral
Left Ventricular Hypertrophy
Left Ventricular Hypertrophy ,[object Object],Normal Left Ventricular Hypertrophy Answer: The QRS complexes are very tall (increased voltage)
Left Ventricular Hypertrophy ,[object Object],LVH ECHOcardiogram Increased QRS voltage As the heart muscle wall thickens there is an increase in electrical forces moving through the myocardium resulting in increased QRS voltage.
Left Ventricular Hypertrophy ,[object Object],[object Object],[object Object],[object Object]
Bundle Branch Blocks
Bundle Branch Blocks ,[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers
Bundle Branch Blocks ,[object Object],Therefore, a conduction block of the Bundle Branches would be reflected as a change in the QRS complex. Right BBB
Bundle Branch Blocks ,[object Object],[object Object],[object Object]
Bundle Branch Blocks ,[object Object],When the conduction pathway is blocked it will take longer for the electrical signal to pass throughout the ventricles.
Right Bundle Branch Blocks ,[object Object],V 1 For  RBBB  the wide QRS complex assumes a unique, virtually diagnostic shape in those leads overlying the right ventricle (V 1  and V 2 ).  “ Rabbit Ears”
Left Bundle Branch Blocks ,[object Object],Normal For  LBBB  the wide QRS complex assumes a characteristic change in shape in those leads  opposite  the left ventricle (right ventricular leads - V 1  and V 2 ).  Broad, deep S waves
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
End of Module VI Advanced 12-Lead Interpretation Proceed to Module VI Practice Quiz on  WebCT
[object Object],[object Object]

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Module 6