ECG: Interpreting ASMI

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ECG: Interpreting ASMI

  1. 1. PROF DR.MAGESHKUMAR’S UNIT DR.S.GEETHALAKSHMI
  2. 2. <ul><li>35 Yr old MR. JAYAKUMAR Came with </li></ul><ul><li>c/o retrosternal compressing chest pain </li></ul><ul><li>2 hrs duration , Radiating to left arm </li></ul><ul><li>Associated diaphoresis & palpitations +nt </li></ul><ul><li>Smoker 15 yrs </li></ul><ul><li>Alcoholic 10 yrs </li></ul><ul><li>Not a k/c/o SHT / DM / CAD pt </li></ul><ul><li>Examn fairly normal </li></ul><ul><li>Vitals stable with a BP of 140 / 90 mm Hg </li></ul>
  3. 4. I II III
  4. 5. SHOWS <ul><li>RATE 100/min </li></ul><ul><li>RHYTHM normal sinus rhythm </li></ul><ul><li>P WAVE present with normal morphology </li></ul><ul><li>PR INTERVAL 0.16 secs </li></ul><ul><li>QRS DURATION normal </li></ul><ul><li>QT INTERVAL 0.32 secs </li></ul><ul><li>ST SEGMENT ELEVATION V1 – V4 </li></ul>
  5. 6. DIAGNOSIS <ul><li>ANTERIOR WALL MI </li></ul><ul><li>what more from ecg ? </li></ul><ul><li>Localize CULPRIT CORONARY VESSEL </li></ul><ul><li>To assess the size of ischemic area </li></ul><ul><li>To be prepared for EXPECTED COMPLICATIONS </li></ul><ul><li>PROGNOSIS – ST segment score(> 15 ) </li></ul><ul><li>Grading of ischaemia </li></ul><ul><li>I – tall peaked symmetric R waves </li></ul><ul><li>ii – ST elevation </li></ul><ul><li>iii – distortion of terminal QRS </li></ul>
  6. 7. CORONARY VASCULAR ANATOMY
  7. 8. Sites of occlusion Proximal l a d Septal Diagonal Distal l a d
  8. 9. ECG CHANGES LOOK AT PROXIMAL L A D MID L A D DISTAL L A D V 1-4 ST ST ST II , III , AVF ST ST (III esp.) ST isoelectric or AVR , ST ST ST V 5 , 6 ST AVL ST CONDUCTION DEFECTS RBBB LAFB
  9. 10. PROXIMAL L A D OCCLUSION
  10. 11. PROXIMAL L A D <ul><li>ST ELEVATION AVR </li></ul><ul><li>ST DEPRESSION IN INFERIOR LEADS , V5,6 </li></ul>
  11. 12. DISTAL L A D OCCLUSION
  12. 13. DISTAL L A D <ul><li>ST DEPRESSION AVR </li></ul><ul><li>ST ISOELECTRIC OR ELEVATED IN INFERIOR LEADS </li></ul>
  13. 14. PROXIMAL TO SEPTAL BR.
  14. 15. PROXIMAL TO SEPTAL BR. <ul><li>ST ELEVATED IN INFERIOR LEADS (ESP III) & AVR </li></ul><ul><li>ST DEPRESSED IN AVL </li></ul>
  15. 16. COMPLICATIONS <ul><li>Involvement of the distal AV conduction </li></ul><ul><li>right bundle branch block (RBBB) </li></ul><ul><li>Left fascicular block, </li></ul><ul><li>Heart failure and </li></ul><ul><li>Ventricular tachycardia and fibrillation </li></ul><ul><li><subacute phase> </li></ul>
  16. 17. To summarize ……..
  17. 18. A SIMPLE CARRY HOME MESSAGE <ul><li>ASMI </li></ul><ul><li>ST elevation in V 1-4 </li></ul><ul><li>reciprocal ST depression in ii ,iii , aVF </li></ul><ul><li>Present absent </li></ul><ul><li> DISTAL L A D </li></ul><ul><li>ST elevation in V1 , a VR </li></ul><ul><li>Present absent ST elevation avr > V1 </li></ul><ul><li>+ RBBB , LAFB </li></ul><ul><li>PROXIMAL MID L A D LT MAIN BR. </li></ul>
  18. 20. DISTAL TO SEPTAL BR.
  19. 21. DISTAL TO SEPTAL

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