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ECG: Myocardial Infarction with CHB


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ECG: Myocardial Infarction with CHB

  1. 1. -Prof .Dr.Gowrishankar’s Unit -Dr.A.Ishwarya
  2. 2. <ul><li>45 year old male patient was brought to ICCU with </li></ul><ul><li>C/O </li></ul><ul><ul><li>CHEST PAIN * 2 HOURS </li></ul></ul><ul><li>K/C/O T2DM/SHT </li></ul><ul><li>VITAL SIGNS </li></ul><ul><ul><li>PR-54/Min </li></ul></ul><ul><ul><li>BP-90/74 mm hg </li></ul></ul><ul><ul><li>JVP RAISED </li></ul></ul><ul><li>O/E </li></ul><ul><ul><li>CVS: S1S2+ </li></ul></ul><ul><ul><ul><li>NO MURMUR </li></ul></ul></ul><ul><ul><li>RS: B/L CREPS+ </li></ul></ul><ul><ul><li>CNS:NFND </li></ul></ul><ul><ul><li>P/A:SOFT </li></ul></ul>
  3. 5. <ul><li>Rate of P wave 80/min </li></ul><ul><li>Rate of QRS complex 60/min </li></ul><ul><li>Not in sinus rhythm </li></ul><ul><li>Duration of QRS <0.12 sec </li></ul><ul><li>P wave inverted in lead II, avf/ upright in aVr </li></ul><ul><li>Varying PR interval </li></ul><ul><li>PP interval constant (0.8 sec) </li></ul><ul><li>RR interval constant (1.12 sec) </li></ul><ul><li>ST elevation in lead II ,III ,aVf/ ST elevation in V3R-V5R,V7-V9 </li></ul><ul><li>ST depression in lead I , aVL </li></ul><ul><li>R>S in Lead V2 & S > R in Lead aVL </li></ul><ul><li>ST depression in V2-V4 (mirrror changes of posterior MI) </li></ul>
  4. 9. Bradyarrhythmia-Type Incidence Sinus Bradycardia 25% Junctional Escape Rhythm 20% Idioventricular escape rhythm 15% I Degree AV Block 15% II Degree AV Block –Type 1 12% II Degree AV Block –Type 2 4% Complete Heart block 15% RBBB 7% LBBB 5% LAFB 8% LPFB 0.5%
  5. 10. <ul><li>Hyper vagotonia </li></ul><ul><li>Ischemia of AV node </li></ul>
  6. 13. Site of block Intranodal Infranodal Site of infarction Inferoposterior Anteroseptal Compromised arterial supply RCA (90%), LCX (10%) Septal perforators of LAD Pathogenesis Ischemia, excess parasympathetic activity Ischemia, necrosis, hydropic cell swelling Predominant type of AV nodal block First-degree (PR > 200 msec) Mobitz type I second-degree Mobitz type II second-degree Third-degree Location Proximal conduction system (His bundle) Distal conduction system (bundle branches) QRS width <0.12/sec [*] >0.12/sec Rate 45-60/min but may be as low as 30/min Often <30/min
  7. 14. Stability of escape rhythm Rate usually stable; asystole uncommon Rate often unstable with moderate to high risk of ventricular asystole Duration of high-grade AV block Usually transient (2-3 days) Usually transient but some form of AV conduction disturbance and/or intraventricular defect may persist Associated mortality rate Low unless associated with hypotension and/or congestive heart failure High because of extensive infarction associated with power failure or ventricular arrhythmias