Myocardial infarction [autosaved]
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This document provides an overview of the definition and types of myocardial infarction (MI) and discusses the coronary anatomy and ECG findings associated with different types of MIs. It defines the criteria for ST elevation MI (STEMI) according to American guidelines and introduces the 5 types of MI. It then discusses ST elevation MI and presents several ECG cases with questions about the diagnoses and culprit vessels. The document provides explanations of ECG findings that suggest conditions like left main coronary artery occlusion, left anterior descending artery occlusion, inferior wall MI, right ventricular infarction, posterior wall MI, and left ventricular aneurysm.
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The document provides steps for analyzing electrocardiograms (ECGs). It discusses evaluating the rhythm, rate, P-wave, PR interval, QRS complex, and other aspects. The key steps are:
1. Analyze the rhythm as regular or irregular and the rate as normal, bradycardia, or tachycardia.
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The document provides steps for analyzing electrocardiograms (ECGs). It discusses evaluating the rhythm, rate, P-wave, PR interval, QRS complex, and other aspects. The key steps are:
1. Analyze the rhythm as regular or irregular and the rate as normal, bradycardia, or tachycardia.
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A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
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Stemi equivalents
1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
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The document discusses various abnormalities that can be seen on an electrocardiogram (ECG). It begins with an overview of the normal ECG and ventricular activation before covering atrial abnormalities like left and right atrial enlargement. Various types of ventricular hypertrophy and conduction blocks like left and right bundle branch block are described. The document then examines myocardial infarction and ischemia, identifying abnormalities seen with anterolateral wall MIs, RV MIs, and old MIs. It also discusses ECG patterns associated with MIs alongside conduction blocks. Finally, it briefly outlines some ECG characteristics seen with hyperkalemia and AV block.
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Atrial enlargement
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
ECG diagnosis of chamber enlargement
This document outlines ECG criteria for detecting enlargement of the heart chambers, including the left ventricle, right ventricle, and atria. Several voltage-based criteria and point scoring systems are described for identifying left ventricular hypertrophy with sensitivities generally around 35-55% and specificities of 85-95%. Signs of right ventricular hypertrophy and chronic pulmonary disease on ECG are also summarized. Biventricular enlargement can be suggested based on meeting criteria for both left and right ventricular hypertrophy simultaneously. Atrial enlargement of the left or right atria is characterized by abnormalities in the P wave morphology and duration.
Bundlebranchblocks
1) Right bundle branch block (RBBB) is characterized by a QRS duration ≥ 120ms and signs of delayed right ventricular activation. It is commonly benign but worsens prognosis when seen in acute myocardial infarction, especially of the proximal left anterior descending artery.
2) Left bundle branch block (LBBB) has a QRS duration ≥ 120ms and signs of delayed left ventricular activation. New onset LBBB indicates the need for thrombolysis in myocardial infarction and worsens prognosis when seen in acute myocardial infarction.
3) Hemiblocks involve delayed activation of only one side of the ventricles. Left anterior hemiblock may mask inferior wall myocardial infarction. Left posterior hemiblock in anterior myocardial infarction
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This document provides information on ECG localization of myocardial infarction. It discusses the branches of the coronary arteries and their blood supply territories. It describes concepts like injury vector, ST elevation and depression cut-offs, and ECG changes seen in different types of MI such as anterior wall MI, inferior wall MI, right ventricular MI, and posterior wall MI. It also discusses ECG patterns that can indicate high-risk coronary artery disease such as left main occlusion. Overall, the document is a guide for using the ECG to localize the site and artery of myocardial infarction.
ECG #5 - ID 168 - Left bundle branch block
A 58-year-old man followed for coronary artery disease presented with an ECG showing sinus rhythm at 88 beats per minute, a prolonged QRS duration of 145 milliseconds consistent with left bundle branch block, and no evidence of right or left ventricular hypertrophy or atrial enlargement. The left bundle branch block precludes diagnosing left ventricular hypertrophy and can mask underlying myocardial infarction.
ECG: Interpreting ASMI
1. A 35-year-old man presented with retrosternal chest pain radiating to the left arm, associated with diaphoresis and palpitations.
2. An electrocardiogram showed ST segment elevation in leads V1-V4 consistent with an anterior wall myocardial infarction.
3. The ECG findings could help localize the culprit coronary vessel, assess the size of the ischemic area, and prepare for potential complications like heart failure, ventricular arrhythmias, and conduction blocks.
ECG Praktis
The document discusses the conduction system of the heart and components of an electrocardiogram (ECG). It provides descriptions of normal sinus rhythm and several types of heart block, including first, second (Mobitz I and II), and third-degree heart block. Characteristics of the rhythm, rate, P wave, PR interval, and QRS complex are described for each type of block.
Ecg interpretation , Upgraded
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The ECG is used to diagnose heart conditions by representing the electrical activity of the heart over time. It can detect abnormalities in heart rhythm, rate, and structure. A standard ECG has 12 leads that examine the heart from different angles. Common things to analyze include rhythm, rate, axis, waves, intervals, and complexes. Various arrhythmias and conduction abnormalities can be identified based on their characteristic ECG patterns.
ECG: WPW Syndrome
A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
Case 004
This ECG shows signs of diffuse subendocardial ischemia/infarction in a 62-year-old man with chest tightness and risk factors of diabetes, hypertension, and kidney disease. The ECG findings include left axis deviation, ST segment depression in multiple leads, and ST elevation in leads aVR and V1, suggesting involvement of the left main coronary artery or proximal LAD and LCx arteries. Cardiac enzymes were elevated. Coronary angiography revealed significant stenoses of the left main, LAD, LCx, and RCA arteries consistent with triple vessel disease.
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Right bundle branch block,Left bundle branch block,Fasicular blocks,Intraventricular conduction blocks,hemiblocks,bifasicular blocks,trifasicular blocks,qRBBB ecg,causes of rbbb,causes of lbbb,Sgarbossa criteria,incomplete blocks,LAFB,LPFB,RAD,LAD
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O evento, promovido pela Clínica Ritmo, clínica especializada no tratamento de Arritmias e Implante de Marcapasso, teve como objetivo abordar todas as formas de arritmias cardíacas e as possibilidades de tratamentos, com temas trazidos a partir de casos reais tratados pelos especialistas da Clínica Ritmo nos últimos cinco anos.
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A 73-year-old male presented with dizziness for 1 year and chest pain for 2 days. His ECG showed left bundle branch block (LBBB) and first-degree atrioventricular block, consistent with possible trifascicular block. Trifascicular block must be confirmed with bundle of His electrogram. The patient has abnormal conduction through one or more divisions of the intraventricular conduction system distal to the bundle of His, presenting as LBBB and first-degree AV block. This suggests involvement of the left and right bundles as well as the AV node, consistent with trifascicular block.
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4th part ECG Basics: cardiac axis Dr Salah Mabrouk Khallaf
4th part ECG Basics: cardiac axis Dr Salah Mabrouk Khallaf
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This document provides an overview of the definition and types of myocardial infarction (MI). It begins by defining ST-elevation MI (STEMI) according to guidelines. It then discusses the 5 types of MI: Type 1 spontaneous MI, Type 2 MI due to oxygen supply-demand imbalance, Type 3 sudden cardiac death, Type 4a PCI-related MI, and Type 4b stent thrombosis MI. It provides examples of ECG patterns associated with different coronary artery occlusions, including anterior wall MI, high lateral MI, inferior wall MI, right ventricular infarction, posterior wall MI, and left ventricular aneurysm. It asks questions to test recognition of these ECG patterns and diagnoses.
Stemi equivalents
1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
Stemi equivalents
1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
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This document contains 7 ECG quiz cases designed to test the reader's ability to identify abnormalities and determine appropriate clinical responses. Each case provides an ECG image and asks the reader to identify any abnormalities, explain their clinical significance, and recommend next steps. The cases cover conditions like Wellens' syndrome, de Winter's pattern, posterior STEMI, Wolff-Parkinson-White syndrome, Brugada pattern, arrhythmogenic right ventricular cardiomyopathy, and hypertrophic obstructive cardiomyopathy. The document emphasizes the importance of recognizing subtle ECG findings that can indicate high-risk cardiac conditions requiring prompt referral or treatment.
STEMI Mimic WHAT IS IT AND HOW TO IDENTIFY IT ?
The document discusses several STEMI mimics that can present with ST segment elevation on ECG but are not actually caused by an acute myocardial infarction. These include early repolarization, left bundle branch block, electrolyte abnormalities, left ventricular hypertrophy, pulmonary embolism, left ventricular aneurysm, Brugada syndrome, pericarditis, and hypothermia. It provides details on the characteristic ECG patterns and clinical features that can help differentiate these conditions from a true STEMI.
STEMI equivalents
1) The document presents 7 cases involving ECG patterns that can indicate acute coronary syndrome without ST elevation. Case 1 describes tall, symmetric T waves in the precordial leads indicating a possible left anterior descending artery occlusion. Case 2 shows biphasic T waves in leads V2-3 consistent with Wellens' syndrome. Case 3 demonstrates deeply inverted T waves in leads V2-3 also indicative of Wellens' syndrome.
2) Case 4 shows ECG changes in leads V1-3 consistent with a posterior myocardial infarction. Case 5 highlights ST elevation in lead aVR that can indicate a left main or proximal left anterior descending artery occlusion. Case 6 applies the Sgarbossa criteria to identify a possible infarction in
CAD PPT.pptx
The ECG is useful for diagnosing and managing patients with chest pain. It can help predict infarct size, prognosis, and localize the site of infarction based on specific ECG patterns. ST elevation myocardial infarction (STEMI) involves ST segment elevation, while non-ST elevation acute coronary syndrome (NSTEACS) includes non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA), which are usually differentiated retrospectively based on cardiac enzyme levels. Common ECG patterns of NSTEACS include ST depression and T wave changes. The morphology, distribution, and magnitude of ST depression provide information about ischemia. Wellens' syndrome and other ECG patterns also provide important clues.
DECIPHERING COMMON ECG FINDINGS IN ED.pptx
ECG in ED. What usually missed and underestimate ECG. STEMI equivalent ST depression. Tachy and brady.
A doctor in ED must know this.
Early management of ACS
Early Management of ACS - Presentation
92 slides
According to latest ACC/AHA guidelines
www.medicalgeek.com
An overview of ACS.pptx
The document discusses acute coronary syndrome (ACS) and its presentation and diagnosis. It notes that South Asians have a higher risk of ACS and develop heart disease earlier. For diagnosis, it examines electrocardiogram (ECG) patterns that differentiate ST-elevation myocardial infarction (STEMI) from non-ST-elevation ACS (NSTE-ACS). It outlines the use of cardiac troponin testing and serial measurements in diagnosis. Evaluation includes assessing symptoms, vital signs, ECG and troponin levels to determine if patients present high or low likelihood features of ACS.
ACUTE CORONARY SYNDROME FOR CRITICAL CARE
The document defines acute coronary syndrome (ACS) as a group of diseases including unstable angina, myocardial infarction, and sudden cardiac death. ACS is classified into STEMI, NSTEMI, or unstable angina based on ECG and cardiac biomarker findings. The diagnosis of ACS involves taking a medical history, performing an ECG, and measuring cardiac biomarkers like troponin and CK-MB. Treatment involves pain relief medications, antiplatelet drugs, anticoagulants, and sometimes revascularization through procedures like angioplasty.
Ecg in athletes and young age
ECG in Athletes is common facing problem in primary care and emergency. clinician must be aware and able to differentiate between normal changes and abnormal ECG that need further investigations
ST SEGMENT IN ECG,ST ELEVATION AND ST DEPRESSION
The document discusses the ST segment of the ECG and various abnormalities that can occur. It notes that the ST segment represents the interval between ventricular depolarization and repolarization. ST segment elevation or depression can indicate myocardial ischemia or infarction. Various conditions are described that can cause ST segment changes, including myocardial infarction in different coronary artery territories, coronary vasospasm, pericarditis, early repolarization, and others. The morphology and patterns of ST segment abnormalities are discussed for evaluating these conditions.
Acute Myocardial infarction
This document provides an overview of acute myocardial infarction (MI), also known as a heart attack. It discusses the definition, causes, risk factors, pathogenesis, classification, diagnosis and management of MI. The diagnosis involves taking a patient history, examining signs and symptoms, electrocardiography, serum analysis and echocardiography. Management is staged and involves pre-hospital, emergency department and post-discharge care, with a focus on reperfusing the blocked artery as quickly as possible, such as through percutaneous coronary intervention or thrombolytic therapy. The goal is to correctly identify the type of MI, treat the patient according to guidelines and manage any complications.
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Presentation the electrocardiogram in the acs patient
Presentation the electrocardiogram in the acs patient
ECG Changes in Myocardial ischemia, myocardial infarction.pptx
ECG Changes in Myocardial ischemia, myocardial infarction.pptx
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2 d echocardiography views
2D echocardiography uses ultrasound waves between 1-20 MHz to generate images of the heart. Ultrasound transducers use piezoelectric crystals to generate and receive ultrasound waves, and different views of the heart are obtained by manipulating the transducer position and orientation. Standard views include the parasternal long and short axis, apical 4-chamber, subcostal, and suprasternal views, which allow visualization of the heart structures and assessment of wall motion.
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
Lv systolic function
This document discusses the echocardiographic evaluation of left ventricular systolic function. It indicates that assessment of LV systolic function is important for diagnosing and managing heart disease and conditions that can affect the heart. The document outlines the indications for evaluating LV systolic function and describes techniques like M-mode, measurements of LV dimensions and volumes, wall motion scoring, and newer techniques using tissue Doppler imaging and speckle tracking echocardiography to assess systolic function parameters. Echocardiography is recommended as the initial imaging modality to evaluate LV systolic function.
Atrial septal defect
This document discusses atrial septal defects (ASDs), which are openings in the septum separating the left and right atria of the heart. It describes the different types of ASDs based on their location, including secundum, primum, sinus venosus, and coronary sinus defects. It discusses the embryology, pathophysiology, natural history, diagnosis and ECG findings of each type. Secundum ASDs are the most common and may close spontaneously in childhood, while primum and sinus venosus defects do not close on their own. Left-to-right shunting can cause right heart volume overload and pulmonary hypertension if not repaired. Echocardiography and ECG
Echo in restrictive cardiomyopathy
This document provides an overview of echocardiographic evaluation of restrictive cardiomyopathy. Key points include:
- Restrictive cardiomyopathy is characterized by a nondilated left ventricle with abnormal diastolic function and typically normal systolic function.
- Causes include infiltrative diseases like amyloidosis and storage diseases. Echocardiography can help diagnose but it is more difficult than other cardiomyopathies.
- Findings include low diastolic volume, normal ejection fraction, diastolic dysfunction with rapid early mitral inflow. Echocardiography helps differentiate restrictive cardiomyopathy from constrictive pericarditis.
Echo in hypertrophic obstructive cardiomyopathies
This document discusses the echocardiographic evaluation of hypertrophic obstructive cardiomyopathy (HCM). Key points include:
- Echocardiography is used to diagnose HCM based on unexplained left ventricular hypertrophy and rule out other causes. Asymmetric septal hypertrophy is a characteristic pattern.
- Doppler echocardiography is used to detect left ventricular outflow tract obstruction at rest and with provocative maneuvers like Valsalva.
- Features like systolic anterior motion of the mitral valve indicate dynamic obstruction and need to be monitored with maneuvers.
- Differential diagnosis includes secondary causes of left ventricular hypertrophy from things like hypertension which present differently on echocard
Echo in cardiomyopathies part 1
This document discusses the echocardiographic evaluation of cardiomyopathies. It defines cardiomyopathy and outlines the major classification systems. The main types discussed are dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, restrictive cardiomyopathy, and unclassified cardiomyopathy. Specific features of dilated cardiomyopathy are then reviewed in detail, including morphological features, causes, Doppler findings, and involvement of the right ventricle and left atrium. Evaluation of diastolic dysfunction and ischemic cardiomyopathy are also summarized.
Echocardiographic evaluation of pericardium
The document discusses echocardiographic evaluation of the pericardium. It describes the normal anatomy of the pericardium and physiology. Small amounts of pericardial fluid are normal but larger accumulations can indicate a pericardial effusion. Echocardiography is useful for diagnosing and characterizing pericardial effusions, identifying pericardial thickening, and evaluating conditions like cardiac tamponade and constrictive pericarditis. CT and MRI can provide additional information about pericardial abnormalities.
Echocardiographic evaluation of aortic regurgitation
This document discusses the echocardiographic evaluation of aortic regurgitation. It describes the causes, signs, and methods used to assess the severity of aortic regurgitation. Key methods to evaluate severity include measuring the vena contracta width, jet width and area, diastolic flow reversal in the aorta, continuous wave Doppler deceleration slope, and pressure half-time. Severe aortic regurgitation is defined as having a vena contracta width over 6 mm or meeting at least 4 other criteria of severe regurgitation on echocardiography.
Echocardiographic evaluation of aortic valve and Aortic stenosis
This document discusses the echocardiographic evaluation of the aortic valve. It describes how to visualize the aortic valve using 2D and M-mode imaging from different views. It discusses the anatomy of the normal trileaflet aortic valve and abnormalities such as bicuspid aortic valve. Doppler assessment of aortic stenosis is also covered, including measurements of peak velocity, mean gradient, and valve area using the continuity equation. The classification and characteristics of aortic stenosis, regurgitation, and other aortic valve abnormalities are summarized.
Contrast echocardiography
Contrast echocardiography uses microbubble contrast agents to improve echocardiographic image quality and assess cardiac structures and function. Second-generation agents can pass through the lungs to opacify the left ventricle. Clinical applications include detecting shunts, assessing ventricular function and volumes, guiding procedures like alcohol ablation, and evaluating perfusion and viability. Optimal settings enhance microbubble signals, like harmonic imaging and intermittent pulses. Contrast is useful when images are suboptimal and helps evaluate many conditions.
Stress echocardiography
Stress echocardiography involves performing echocardiography at rest and during periods of stress, either through exercise or pharmacologically. It can evaluate cardiac function and detect regional wall motion abnormalities indicative of ischemia. Exercise stress echocardiography is commonly done with treadmill or bicycle exercise to detect coronary artery disease. Pharmacological stress with dobutamine or vasodilators like dipyridamole can be used for patients unable to exercise. The test aims to stimulate the heart and reveal any impairments in cardiac function during higher demand.
Tissue doppler Echocardiography (TDE)
Tissue Doppler echocardiography allows assessment of myocardial motion using Doppler ultrasound. It uses frequency shifts of ultrasound waves to calculate myocardial velocity, focusing on lower velocities than blood flow Doppler. There are two techniques: pulsed TDE uses a sample volume gate while color-coded TDE uses autocorrelation to display multigated velocity data superimposed on images. TDE is useful for evaluating systolic and diastolic left ventricular function by measuring velocities of the mitral annulus, and can help distinguish conditions like constrictive pericarditis from restrictive cardiomyopathy.
Doppler echocardiography
Doppler echocardiography uses the Doppler effect to analyze the velocity and direction of blood flow. There are several Doppler modalities used in cardiac evaluation including continuous wave Doppler, pulsed wave Doppler, and color flow Doppler. Continuous wave Doppler measures very high velocities, pulsed wave Doppler samples local low velocities, and color flow Doppler visually displays velocities using color scales. The Nyquist limit defines the maximum detectable velocity and avoiding aliasing. Tissue Doppler also evaluates myocardial velocities. The Bernoulli equation relates velocity and pressure gradients which allows Doppler to estimate valve pressures.
Echocardiographic evaluation of mitral regurgitation
This document discusses the echocardiographic evaluation of mitral regurgitation. It begins by listing common causes of MR such as mitral valve prolapse, rheumatic heart disease, and cardiomyopathy. It then outlines the indications for echocardiography in diagnosing and assessing the severity of MR. Key aspects of the echocardiogram are described such as the Carpentier classification of valve abnormalities, Doppler methods for grading severity including jet area and vena contracta width, and structural parameters like left atrial and ventricular size. Quantitative measurements using the PISA method to calculate regurgitant volume and orifice area are also summarized.
2 d echocardiography views
2D echocardiography uses ultrasound waves between 1-20 MHz to generate images of the heart. Ultrasound transducers use piezoelectric crystals to generate and receive ultrasound waves, and different views of the heart are obtained by manipulating the transducer position and orientation. Standard views include the parasternal long and short axis, apical 4-chamber, subcostal, and suprasternal views, which allow visualization of the heart structures and assessment of wall motion.
NARROW QRS TACHYCARDIA PART II
1) Atrial tachycardias can be focal, triggered, or reentrant and include both macroreentrant circuits and focal mechanisms. Sinus node reentry is considered a specific type of focal atrial tachycardia.
2) AV nodal reentrant tachycardia (AVNRT) is a common form of reentrant tachycardia that involves dual pathways in the AV node - a fast and slow pathway. Typical AVNRT uses the slow pathway anterograde and fast pathway retrograde.
3) Other reentrant tachycardias discussed include atypical AVNRT variants, orthodromic and antidromic AV reentrant
How to protect yourself from covid 19
This document from the CDC provides guidelines for protecting yourself from COVID-19, including practicing social distancing, frequent hand washing, self-quarantining if sick, cough etiquette, and disinfecting surfaces. The main points are to avoid close contact with others, wash hands often with soap and water or hand sanitizer for 20 seconds, and clean and disinfect frequently touched surfaces daily. Facemasks are only recommended if sick or caring for someone who is sick.
Narrow qrs tachycardia part 1
This document discusses various types of narrow complex tachycardia, including their characteristics and causes. It describes sinus tachycardia, inappropriate sinus tachycardia, atrial tachycardia, multifocal atrial tachycardia, atrial fibrillation, and atrial flutter. For each type, it provides details on electrocardiogram patterns such as P wave morphology, axis, and relationships to QRS complexes that can help distinguish the different supraventricular arrhythmias.
Sinus node dysfunction
This document discusses sinus node dysfunction (SND), which refers to dysfunction of the sinoatrial node that can cause various electrocardiogram abnormalities like sinus bradycardia, sinus pauses, and inadequate heart rate response to activity. Common causes of SND include sinus node fibrosis, medications that depress sinus node function, infiltrative diseases, inflammatory diseases, and sinus node artery disease. The document recommends permanent pacing for patients with SND who experience symptomatic bradycardia or pauses, as well as those with chronotropic incompetence. It describes various ECG patterns that can occur in SND such as sinus bradycardia, sinus pause/arrest, sinus node exit block, and chronotropic incompetence.
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Myocardial infarction [autosaved]
- 1. Approach to Myocardial Infarction Dr. Sruthi Meenaxshi (PDF) VMCRH
- 2. Definition • According to the American College of Cardiology/American Heart Association guidelines for STEMI, there must be “new ST segment elevation at the J point in at least two contiguous leads of ≥ 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2-V3 and/or of ≥ 1 mm (0.1 mV) in other contiguous chest leads or the limb leads.” This means 1 millimeter in any two contiguous leads, except leads V2 or V3, where the elevation must be 2 mm in men or 1.5 mm in women.
- 4. New concepts
- 10. Type 1 Myocardial infarction
- 11. Type 2 Myocardial infarction due to oxygen supply demand mismatch
- 13. Type 2 MI due to oxygen supply and demand imbalance
- 14. Type 3 sudden cardiac death due to MI when cardiac biomarkers are unavailable
- 15. Type 4a (PCI related MI)
- 16. Type 4b MI due to stent thrombosis
- 17. Type 5 MI ( CABG related])
- 18. CORONARY ANATOMY
- 22. Anterior wall MI
- 24. DE WINTER “T” WAVES
- 25. A 55year old male presented to ED with acute onset chest pain ,diaphoresis and palpitation . Trop T and I was elevated .What is the probable diagnosis ?Comment on ECG and Culprit vessel?
- 26. LMCA Occlusion • Typical ECG findings with LMCA occlusion: • Widespread horizontal ST depression, most prominent in leads I, II and V4- 6 • ST elevation in aVR ≥ 1mm • ST elevation in aVR ≥ V1 • ST Elevation in aVR may also be seen with: • Proximal left anterior descending artery (LAD) occlusion • Severe triple-vessel disease (3VD) • Diffuse subendocardial ischaemia – e.g. due to O2 supply/demand mismatch, following resuscitation from cardiac arrest
- 27. A 45year old came to ED with acute onset chest pain .Diagnosis?
- 28. LAD OCCLUSION PROXIMAL TO SEPTAL
- 29. High lateral MI
- 30. South African Flag sign
- 31. What is your diagnosis?
- 32. Inferior wall MI
- 33. A 56 year old male presented to ED is acute onset chest pain ,cardiac biomarkers are elevated.What is your diagnosis?
- 34. 50 year old presented with acute onset chestpain ,breathelessness ,Ecg shows as below .what is your diagnosis?
- 35. A 55 yearold man presented to ED with acute onset chest pain,palpitation and breathelessness . What is your diagnosis?
- 36. Comment on Ecg and tell your diagnosis?
- 38. Right ventricular infarction In patients presenting with inferior STEMI, right ventricular infarction is suggested by the presence of: •ST elevation in V1 – the only standard ECG lead that looks directly at the right ventricle. •ST elevation in lead III > lead II – because lead III is more “rightward facing” than lead II and hence more sensitive to the injury current produced by the right ventricle. Right ventricular infarction is confirmed by the presence of ST elevation in the right-sided leads (V3R-V6R).
- 39. A 44 year old female presented with the following ecg finding ,no chestpain with minimal increase cardiac biomarker ? What is your diagnosis ?
- 41. Wellens Pattern? What is it? Why is it significant?
- 42. Comment on the Ecg and give a probable Diagnosis?
- 43. Posterior wall MI • Posterior MI is suggested by the following changes in V1-3: • Horizontal ST depression • Tall, broad R waves (>30ms) • Upright T waves • Dominant R wave (R/S ratio > 1) in V2
- 44. LV aneurysm • A LV aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural MI (usually anterior). • Without knowing the persons past medical history, the ECG changes of an aneurysm may mimic an acute ST segment elevation MI. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2. In an inferior aneurysm it would be in lead II, III and aVF. • The only way to be sure of an LV aneurysm diagnosis on an ECG (not from an acute MI) is to have the patient’s history of a prior heart attack and cardiac imaging to document the presence of an aneurysm. • The shape of the ST elevation is also relatively unique and has been described as “coving”.
- 45. LV aneurysm
- 46. Thankyou