ECG

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ECG

  1. 1. Action potential “AP” Electrocardiograph “ECG” Hamad Emad Dhuhayr
  2. 2. CONTENTS 1. SOEPEL 2. AP 3. ECG
  3. 3. SUBJECT: Presenting Complaint An 81 year-old Saudi male is admitting to hospital with worsening abdominal pain over the last 2-3 days. There is no chest pain or dsyponea (shortness of breath), however she complains of nausea and vomiting. Past Medical History On examination of the patient's history it appears that he has a history of hypertension,Type 2 Diabetes mellitus (formerly NIDDM), coronary artery disease status post myocardial infarction (CAD S/P MI) 5 years ago and chronic abdominal pain for the last 2 years without a clear reason. SOEPEL
  4. 4. OBJECTIVE: taking history, physical examination VITAL SIGNS: *Physical Examination 38.8 C RR: 16/min 78 bpm 210/100 mm/Hg SOEPEL
  5. 5. EVALUATION (DD): Myocardiac infraction Appendicitis Peptic ulcer PLAN: ECG , ckmp and troponin *i-t* blood test. ELABORATION: surgical intervention SOEPEL
  6. 6. LEARNING GOALS: AP - ECG SOEPEL
  7. 7. AP
  8. 8. Localization - Myocardial Infarct Localization ST elevation Reciprocal ST depression Coronary Artery Anterior MI V1-V6 None LAD Septal Mi V1-V4, disappearance of septumQ in leads V5,V6 none LAD Lateral MI I, aVL,V5,V6 II,III, aVF (inferior leads) LCX Inferior MI II, III, aVF I, aVL (lateral lead) RCA (80%) or LCX (20%) Posterior MI V7,V8,V9 high R inV1-V3 with ST depressionV1-V3 > 2mm (mirror view) RCA or LCX RightVentricle MI V1,V4R I, aVL RCA Atrial MI PTa in I,V5,V6 PTa in I,II, or III RCA 11 The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG).
  9. 9. AnteriorWall V3, V4 • Left anterior chest • Positive electrode on anterior chest 12 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May-14
  10. 10. Septal Wall  V1, V2 ◦ Along sternal borders ◦ Look through right ventricle & see septal wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 1324-May-14
  11. 11. Practice 14 Anteroseptal MI ST elevations V1, V2, V3, V4 24-May- 14January 2004
  12. 12. 15 Lateral Wall  I and aVL ◦ View from Left Arm  ◦ lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May- 14January 2004
  13. 13. Lateral Wall  V5 and V6 ◦ Left lateral chest ◦ lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 1624-May-14
  14. 14. LateralWall • I, aVL,V5,V6 • ST elevation suspect lateral wall injury 17 Lateral Wall 24-May-14
  15. 15. Lateral MI 1824-May-14
  16. 16. 19 Inferior Wall  II, III, aVF ◦ View from Left Leg  ◦ inferior wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 24-May-14
  17. 17. Inferior MI 2024-May-14
  18. 18. Posterior Leads • Posterior leadsV1,V2 • Posterior Infarct with ST Depressions and/ tall R wave • RCA and/or LCXArtery ST elevation inV7,V8,V9. • 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. Dr. UZMA ANSARI 21 24-May- 14January 2004
  19. 19. 24-May-14Dr. UZMA ANSARI 22
  20. 20. ECG 1.The ECG above belongs to a patient with stable angina pectoris.The patient complained of effort angina in the last 2 weeks. Coronary angiography was performed and then the patient was referred to coronary artery bypass graft operation because of 3 vessel disease. ST segment flattening is one of the first signs of coronary ischemia and generally preceedes ST segment depression.

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