What about this ST and T waves ( ECG sessions )
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This document provides information on interpreting electrocardiograms (ECGs) for various cardiac conditions: 1) It describes the criteria for early repolarization, including widespread but minor ST elevation concentrated in precordial leads, J point elevation, and stable ECG patterns over time. 2) It compares early repolarization to pericarditis, noting that pericarditis shows generalized ST elevation, PR depression, and evolving ECG changes. 3) Examples are given of ECG patterns indicating acute pericarditis, hyperacute T waves, de Winter complexes indicating proximal LAD lesions, posterior myocardial infarction, and left main coronary artery occlusion. 4) The importance of differentiating right ventricular myocardial
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What about this ST and T waves ( ECG sessions )
- 1. Morning Educational Activity Rashid A. M. Abuelhassan R4, Emergency Medicine
- 3. Early Repolarization CRETERIA • wide spread ST elevation (90% < 2 mm in precordial leads, and < 0.5 mm in limb leads) with precordial > limb leads • J point elevation • concave initial upsloping of ST segment • notching/irregular contour of J point • prominent concordant T waves • stability of ECG over time
- 4. • 38, m, Chest pain
- 5. Acute pericarditis • Widespread concave ST ↑ and PR ↓ throughout most of the limb and precordial leads. • Reciprocal ST ↓ and PR ↑ in lead aVR • Sinus tachycardia is common in acute pericarditis due to pain /effusion.
- 6. Early Repolarization Vs. PERICARDITIS ER PERICARDITIS ST ↑ limited to the precordial leads Generalised ST ↑ Absence of PR ↓ Presence of PR ↓ Prominent T waves Normal T wave amplitude ST segment / T wave ratio < 0.25 ST segment / T wave ratio > 0.25 “fish-hook” appearance in V4 Absence of “fish hook” appearance in V4 ECG changes relatively stable over time ECG changes evolve over time
- 7. 49 y man 1/2hour chest pain.
- 8. Hyperacute T waves •FAT • w i d e • with a blunt peak • poor R-wave progression (especially V3). • Sometimes loss of precordial T-wave balance (when the upright T wave is larger than that in V6).
- 11. De Winter ST/T-Wave Complexes 2% of total proximal LAD lesion • Precordial ST-segment depression at the J-point • Tall, peaked, symmetric T waves in the precordial leads • Lead aVR shows slight ST-segment elevation in most cases
- 13. Posterior MI • ST-segment depression • Prominent and broad R wave (>30ms) • Relative tall R waves in precordial leads • R/S wave ratio >1.0 in lead V2 • Prominent, upright T wave • Combination of horizontal ST-segment depression with upright T wave
- 15. LMCA Occlusion occlusion of the proximal left anterior descending artery and severe multivessel coronary artery disease * findings ST elevation in aVR ≥ 1mm ST elevation in aVR ≥ V1 ST depression typically seen in lateral
- 17. 69years, F, c/o sever chest pain,
- 18. Pt is saying “ Doctor I cant speak , give me something for the pain “ • What will you give ?
- 19. Why is it important to differentiate • ECG Findings: • ST elevation in right-sided V leads (V4 R, V5 R) • ST elevation greater in lead III than lead II suggests RV MI • ST elevation in the normally obtained V1 also strongly suggests RV MI • Often associated with inferior MI and/or posterior MI
- 20. What is this
- 22. Thank you
Editor's Notes
- CRETERIA wide spread ST elevation (90% < 2 mm in precordial leads, and < 0.5 mm in limb leads) with precordial > limb leads J point elevation concave initial upsloping of ST segment notching/irregular contour of J point prominent concordant T waves stability of ECG over time
- Widespread concave ST ↑ and PR ↓ throughout most of the limb and precordial leads. Reciprocal ST ↓ and PR ↑ in lead aVR Sinus tachycardia is common in acute pericarditis due to pain /effusion.
- Stage 1 – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks) Stage 2 – normalization of ST changes; generalized T wave flattening (1 to 3 weeks) Stage 3– Flattened T waves become inverted (3 to several weeks) Stage 4 – ECG returns to normal (several weeks onwards)
- FAT w i d e with a blunt peak poor R-wave progression (especially V3). Sometimes loss of precordial T-wave balance (when the upright T wave is larger than that in V6).
- NOTE: The normal T wave in V1 is inverted. An upright T wave in V1 is considered abnormal — especially if it is tall (TTV1), and especially if it is new (NTTV1).
- Hyperkalemia
- Precordial ST-segment depression at the J-point Tall, peaked, symmetric T waves in the precordial leads Lead aVR shows slight ST-segment
- LMCA Occlusion findings ST elevation in aVR ≥ 1mm ST elevation in aVR ≥ V1 ST depression typically seen in lateral
- Right side MI
- nferolateral STEMI. Posterior extension is suggested by: Horizontal ST depression in V1-3 Tall, broad R waves (> 30ms) in V2-3 Dominant R wave (R/S ratio > 1) in V2 Upright T waves in V2-3
- Marked ST elevation in V7-9 with Q-wave formation confirms involvement of the posterior wall, making this an inferior-lateral-posterior STEMI (= big territory infarct!).