This document provides an overview of interpreting 12-lead electrocardiograms (ECGs) for myocardial infarction (MI). It reviews ECG waves, intervals, and segments. It defines ischemia, injury, and infarction and describes associated ECG changes. It identifies the five major infarct areas and corresponding lead changes. Color coding is used to indicate changes for anterior, inferior, lateral, posterior, and subendocardial MIs. Examples of ECG strips demonstrate single and combined infarct patterns. Cardiac enzymes that indicate infarction and their time courses are also reviewed.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Objectives
review the ECG waveform and intervals
Define myocardial ischemia, injury and infarction
Identify the 5 major infarct areas on the 12 lead
Name occluded arteries common to the area
Differentiate ECG changes reflecting ischemia,
injury and infarction
Identify cardiac enzymes associated with ACS
2
5. The 12-Lead view
Each limb lead I, II, III, AVR, AVL, AVF records
from a different angle
All six limb leads intersect and visualize a frontal
plane
The six chest leads (precordial) V1, V2, V3, V4,
V5, V6 view the body in the horizontal plane to the
AV node
The 12 lead ECG forms a camera view from 12
angles
5
7. Precordial lead snapshots
Think of each
precordial lead as a
horizontal view of
the heart at the AV
node
With the limb leads
and the precordial
leads you have a
snapshot of heart
portions
7
8. Unipolar and Bipolar
Limb leads I, II, III are bipolar and have a negative
and positive pole
Electrical potential differences are measured between
the poles
AVR, AVL and AVF are unipolar
No negative lead
The heart is the negative pole
Electrical potential difference is measured betweeen the
lead and the heart
Chest leads are unipolar
The heart also is the negative pole
2004 Anna Story8
9. Lead Placement is Important
Each positive electrode
acts as a camera
looking at the heart
Ten leads attached for
twelve lead diagnostics.
The monitor combines 2
leads.
Mnemonic for limb
leads
White on right
Smoke(black) over
fire(red)
Snow(white) on
grass(green) 2004 Anna Story 9
18. The ECG Tracing: Waves
P- wave
Marks the beginning of the cardiac cycle and
measures the electrical impulse that causes atrial
depolarization and mechanical contraction
QRS- Complex
Measures the impulse that causes ventricular
depolarization
Q-wave- may or may not be evident on the ECG
R-wave- first upward deflection following P wave
S-wave- the first downward deflection following the R-
wave
T- wave
Marks ventricular repolarization that ends the
cardiac cycle 18
19. Intervals and Segments
P-R interval-
Time interval for impulse to go from the SA to the AV node
normal 0.12-0.20 secs
QRS Interval
Time interval for impulse to go from AV node to stimulate Purkinjie
fibers
Less than 0.12 secs
QT Interval
Time interval from beginning of depolarization to the end of
repolarization
Should not exceed ½ the length of the R-R
ST segment
end of the S to the beginning of the T
19
21. MI Definition
A result of occlusion of arterial flow to the myocardium.
Ischemia, injury and necrosis is result
Occlusion occurs via spasm, blood clot or stenosis
21
23. ECG Changes: Injury
ST segment elevation of greater than 1mm in at least 2
contiguous leads
Heightenedөндөрсөх or peaked T waves
Directly related to portions of myocardium rendered
electrically inactive
23
Baseline
24. ECG Changes: Infarct
Significant Q-wave where none previously existed
Why?
Impulse traveling away from the positive lead
Necrotic tissue is electrically dead
No Q-wave in Subendocardial infarcts
Why?
Not full thickness dead tissue
But will see a ST depression
Often a precursor to full thickness MI
Criteria
Depth of Q wave should be 25% the height of the R wave
Width of Q wave is 0.04 secs
Diminished height of the R wave
24
25. Evolving MI and Hallmarks of AMI
25
1 year
•Q wave
•ST Elevation
•T wave inversion
26. Dissecting the 12 Lead ECG
Horizontal marks time
Vertical marks amplitude
6 limb leads
6 precordial leads
Positioning measures 12 perspectives or views of
the heart
The 12 perspectives are arranged in vertical
columns
Limb leads are I, II, III, AVR, AVL, AVF
Precordial leads are V1, V2, V3, V4, V5, V6
26
29. Color Coding ECG’s Anterior
Yellow indicates V1, V2,
V3, V4
Anterior infarct with ST elevation
Left Anterior Descending Artery
(LAD)
V1 and V2 may also indicate septal
involvement which extends from
front to the back of the heart along
the septum
Left bundle branch block
Right bundle branch block
2nd Degree Type2
Complete Heart Block
29
33. As an aside….
Right sided EKG
Ever heard of it?
Ever done one?
Think about it…..
For your cases that are clearly inferior MI’s
Obtain a dextrocardiogram whenever ST segment elevation is
noted in Inferior leads
33
34. Right Sided EKG????
RVI occurs around 40% in
inferior MI’s
Significance
Larger area of infarct
Both ventricles
Different treatment
Right leads “look” directly at
Right Ventricle and can
show ST elevations in leads
II. III. AVF, V4R , V5R and
V6R
Occlusion in RCA and
proximal enough to involve
the RV
34
The single most accurate
tool used in measuring RVI.
90% sensitive and specific
36. Color Coding ECG- Lateral
Red indicates leads
I, AVL, V5, V6
Lateral Infarct with
ST elevations
Left Circumflex
Artery
Rarely by itself
Usually in combo
36
38. Color Coding ECG- Posterior
Green indicates leads V1,
V2
Posterior Infarct with ST
Depressions and/ tall R wave
RCA and/or LCX Artery
Understand Reciprocal changes
The posterior aspect of the
heart is viewed as a mirror
image and therefore
depressions versus elevations
indicate MI
Rarely by itself usually in
combo
38
40. Color Coding ECG- SubEndo
No color for
SubEndocardial infarcts
since they are not
transmural
Look for diffuse or
localized changes and
non – Q wave
abnormalities
T-wave inversions
ST segment depression
40
42. More than one color shows abnormality
A combination of infarcts such as:
Anterolateral yellow and red
Inferoposterior blue and green
Anteroseptal yellow and green
42
66. Cardiac Enzymes Indicating Infarct
Normals
CPK- 10-155u/liter
begin rise 3-6 hours and peaks 12-24 with return to norm 3-5
days
CPK-MB < than 5% IU/liter
LDH 85-200 IU/liter
Begin rise 12 hours, peaks 36-72 and normal around 10 days
LDH 1- 18.1% - 29% of total
LDH 2- 27.4% to 37.5% of total
66
67. Cardiac Enzymes Indicating Infarct
Troponins- Now the
Gold Standard!
Rises after 3-6 hours
Negative Troponin
within 6 hours of
onset of S&S rules
out the MI
Peaks at about 20
hours
May be raised for 14
days
67
68. Cardiac Enzymes Indicating Infarct
Troponin T
84% sensitivity for MI 8 hours after onset of symptoms
22% for unstable angina
Advantages
Highly sensitive for detecting myocardial ischemia
Levels may help to stratify risks
Disadvantages
Less specific than Troponin I
Increased in angina
Increased in chronic renal failure
68
69. Cardiac Enzymes Indicating Infarct
Troponin I
90% sensitivity for MI 8 hours after onset of S&S and
95% specificity
Level greater than 1.2 suggest MI
Negative rules out MI
Obtain two negative troponin values 4 hours apart
Normally exceedingly low
Even a small elevation indicates
myocardial damage
69