12 Lead ECG Interpretation – Part 3 withnarr

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This is the third and final installment on 12 Lead ECG Interpretation. Keep an eye out for future topics

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12 Lead ECG Interpretation – Part 3:

12 Lead ECG Interpretation – Part 3 Understanding ST Elevation MI’s P. Johnson; BA, NREMT-P, WV-MCCP

Review notes from today’s in-class lecture :

authorstream.com pjohnson_ALSEDU Review notes from today’s in-class lecture Course Textbooks: Bob Page’s 12 Lead ECG Interpretation, & Barbara Aehlert’s Paramedic Practice Today

Objectives::

Objectives: Describe the Myocardial Coronary Blood supply Name the major coronary arteries and the regions of the heart to which they supply blood Discuss the benefits, limitations, and pitfalls of ECG evidence in AMI Recognize ST segment elevation, ST depression, T wave inversion, and pathological Q wave formation Describe the ECG changes that indicate reciprocal changes on the ECG

Objectives::

Objectives: Describe which leads are related to the various areas of the heart. Describe a systematic approach to assessing 12- leads for an MI with the “ISAL” method and locating areas of reciprocal changes.

Coronary Blood Supply - Review:

Coronary Blood Supply - Review

Right Coronary Artery (RCA)::

Feeds blood supply to: Right ventricle Inferior wall and posterior wall of the left ventricle SA node in 55% of people AV nodes in 90% of people Don’t forget the posterior fascicle of the LBB Right Coronary Artery (RCA):

LCA – Left Anterior Descending (LAD): :

LAD feeds – Anterior wall of the left ventricle Intraventricular septum RBB, LBB, and both fascicles of the LBB LCA – Left Anterior Descending (LAD):

Left Coronary Artery: :

Left Circumflex Branch feeds – Lateral and posterior walls of the left ventricle SA node in 45% of patients AV nodes 10% of patients Left Coronary Artery:

ECG changes in the Setting of an MI:

ECG changes in the Setting of an MI

Triage Criteria:

ST segment elevation or new onset of a LBBB T wave inversion or ST segment depression Nondiagnostic ECG Triage Criteria

ST segment elevation:

Indicators: Injury ST segment elevation greater than 1mm (2mm is septal leads) Present in two or more related or contiguous leads Measure at J point to baseline ST elevation = acute transmural injury (all three layers of the heart are damaged) ST segment elevation

Depth of Damage::

Depth of Damage:

ST segment depression:

ST depression is considered reciprocal to the elevation and confirms the diagnosis of an MI Causes of ST depression: Reciprocal to ST elevation Ischemia or subendocardial injury Certain meds such as digitalis ST depression without ST elevation Ischemia or injury to the subendocardial wall A single layer of heart muscle. ST segment depression

ST Segment Depression: :

ST Segment Depression:

Inverted T waves:

Early sign of ACS and myocardial ischemia BASELINE 12 lead should be ascertained before NTG administration NTG can reverse/ reperfuse ischemia thus removing ST changes NTG can be diagnostic in proving the existence of ACS Inverted T waves

T Wave Inversion: aVL, V4-V6 :

T Wave Inversion: aVL , V4-V6

Pathological Q waves:

Signifies infarction, or death of tissue Q wave must be more than 40ms wide (0.04sec) or a third the R wave height to be pathological IF seen with ST elevation, indicates acute ongoing myocardial infarction. Pathological Q waves

Locating the Myocardial Infarction::

Locating the Myocardial Infarction:

ISAL::

ISAL: I Inferior See Septal All Anterior Leads Lateral

Acute MI Chart with reciprocal changes:

Inferior (RCA) II, III, F I, aVL Septal (LAD) V1, V2 Anterior (LAD) V3, V4 II, III, F Lateral (CIRC) V5, V6, I, L II, III, F Acute MI Chart with reciprocal changes

Inferior Wall MI::

Inferior Wall MI:

Inferior Wall MI:

Inferior Wall MI

Septal Wall MI: :

Septal Wall MI:

Anterior Wall MI:

Anterior Wall MI

AnteroSeptal Wall MI:

AnteroSeptal Wall MI

Lateral Wall MI:

Lateral Wall MI

Lateral Wall MI:

Lateral Wall MI

Practice Makes Perfect!:

Practice Makes Perfect!

Inferior Wall MI: :

Inferior Wall MI:

Inferior Wall MI – Right Coronary Artery!:

Inferior Wall MI – Right Coronary Artery!

Lateral Wall MI:

Lateral Wall MI

Lateral Wall MI: Circumflex of LCA:

Lateral Wall MI: Circumflex of LCA

AnteroSeptal Wall MI:

AnteroSeptal Wall MI

AnteroSeptal Wall MI – LAD of the LCA:

AnteroSeptal Wall MI – LAD of the LCA

authorstream.com:

authorstream.com pjohnson_ALSEDU For review of this and other power point presentations after completion of your course, please visit me at: authorstream.com Channel: paramedicedu

Thank you!:

Thank you! Pictures from: Course Text-Bob Page: 12 Lead ECG Interpretation textbook, Barbara Aehlert : ECG Made Easy & Paramedic Practice Today, Microsoft clip art, and Personal ECG stock

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