1 / 85

ECG predictors of culprit artery in acute myocardial infarction

ECG predictors of culprit artery in acute myocardial infarction. Dr.Deepak Raju. North American Societies of Imaging divided left ventricle into 4 walls– septal,anterior , lateral and inferior and subdivided into 17 segments.

Faraday
Download Presentation

ECG predictors of culprit artery in acute myocardial infarction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ECG predictors of culprit artery in acute myocardial infarction Dr.DeepakRaju

  2. North American Societies of Imaging divided left ventricle into 4 walls–septal,anterior, lateral and inferior and subdivided into 17 segments

  3. LAD- AW(1,7,13) by diagonals ,ant.septum (2,8,14) by septalbranches,RBB by 1stseptal ,apex(17) &sometimes part of seg.15 as wraps around apex(80%) • RCA-RV,IW(4,10,15),inf.septum(3,9,15),part of lat.wall(5,11,16)if dominant • LCX-anterior lateral wall(6,12,16),inferior lateral wall(5,11) part of inf wall(4)and seg10&15 if dominant

  4. LV divided into two zones –anteroseptal and inferolateral • 12 different locations of coronary occlusions 6 in the anteroseptal zone and 6 in the inferolateral zone can be recognised

  5. Anteroseptal zone-LAD and branches • Proximal to S1 & D1 • Prox to D1,distal to S1 • Distal to S1&D1 • Prox to S1 ,distal to D1 • Selective D1–D2 occlusion • Selective S1–S2 occlusion

  6. Proximal to S1 & D1 • Large area of infarct • 31% cases (Engelen et al;JACC 1999) • Injury vector points upward,anteriorly • Right or left depending on predominentseptal or diagonal invt.

  7. Proximal to S1 & D1

  8. ECG pattern • ST↑ in V1 to V4−5 and aVR • ST↓ in II, III, aVF and V5−6 • ST ↑ in aVL or aVR depending on predominentinvt. of lateral or septal • ST dep. III+aVF≥2.5 mm s/o LAD prox to D1(Fiol 2006) • ST elev.in aVR+V1>ST dep V6-s/o LAD prox to S1(Fiol,2006) • ST dep II>III

  9. Prox to D1,distal to S1 • Injury vector upward ,anteriorly and to left • 11% cases • Large infarct-basal anterolateral may be spared

  10. Prox to D1,distal to S1

  11. ECG pattern • ST↑ inV2 toV5−6,I,aVL • ST ↓ in II,III,aVF • ST ↓ in III>II • Wrap around LAD-prox. to D1-Lead III ST dep.with a positive T &ST elevation in aVL(Porter et al 1998)

  12. Distal to S1&D1 • Area at risk involves inferior third of LV-apical infarction & some invt of inf wall • Injury vector directed anteriorly,downward and to left • 48% of cases

  13. Distal to S1&D1

  14. ECG pattern • ST↑ in V2 toV4−5,not in V1 • Slight ST↑ in II,III,aVF,not in aVR(slight ST dep) • ST elev.II>III • ST elev. In V3-4> V1 • Short LAD less evident changes

  15. Prox to S1 ,distal to D1 • 11% cases • Injury vector downward anterior and to right

  16. Prox to S1 ,distal to D1

  17. ECG pattern • ST↑ in V1 to V4, V5,aVR • ST↑ in II, III(III>II) • ST↓ in V6

  18. Criteria

  19. Sensitivity low&specificity higher-absence of a criteria may not help • ST ↑ in V1 <2.5 failed to differentiate b/w prox. and distal • ST ↑ in a VL did not have much significance,ST dep. helped to localise • Q in V4-6 specific for distal to S1-presence of septal vector facilitating Q formation

  20. Selective D1–D2 occlusion • Mid and apical antr. &mid and apical lateral wall • Injury vector –upward ,left ,anterior

  21. Selective D1–D2 occlusion

  22. Ecg pattern • ST↑ in I, aVL and sometimes V2 to V5−6 • ST↓ in II, III, aVF(ST dep.III>II) • ST↓ in V2-3 s/o D1+LCX or RCA

  23. Selective S1 occlusion-antr.,upward &right

  24. Ecg pattern • ST↑ in V1−2, aVR • ST↓ in I, II, III, aVF, V6(ST dep.II > III)

  25. Algorithm for localisation-ST↑ant. leads

  26. ST ↑in ant. &inf. leads

  27. Inferolateral zone-LCX&RCA • Proximal RCA occlusion • Distal RCA occlusion • Dominant RCA occlusion • Proximal LCX occlusion • OM occlusion • Dominant LCX occlusion

  28. Proximal RCA occlusion • Infwall,inferior part of septum,RV • Downward and to right • Sagittal plane-anterior if predominent RV invt,otherwise posterior • Changes in right leads transient • Lead V1 equally useful(Fiol 2004)-v1 equiphasic or elevated s/o RV invt.

  29. Proximal RCA occlusion

  30. Ecg pattern • ST↑ in II, III,aVF(III > II) • ST↓ in I,aVL • ST↑ in V4R with positive T • ST isoelectric or elevated in V1

  31. Distal RCA occlusion-downward,right and posterior

  32. Ecg pattern • ST↑ in II,III,andaVF(III > II) • ST↓ in I and aVL • ST↓ in V1−3 • Magnitude of ST elevation in inf leads>change in precordial leads

  33. Dominant RCA • Inferolateral wall also involved • Downward and to right • Anterior or posterior depends on RV invt • ST elevation in lateral leads-local injury vector

  34. Dominant RCA

  35. ECG pattern • ST↑ in II, III, aVF(III > II) • ST↓ in V1−3 < ST ↑ in II, III, aVF. • Prox.RCA occlusion-ST in V1−3 ↑/equiphasic • ST dep in V1 if distal RCA • ST ↑ in V5−6 ≥ 2mm(Nikus ,2004)

  36. Proximal LCX • Lateral wall and inferior wall(inferobasalseg.) • Downward ,posteriorly and to left

  37. Proximal LCX

  38. Ecg pattern • ST↓ in V1−3 greater than ST↑ in inferior leads • ST↑ in II, III, aVF(II >III) • Usually ST↑ in V5−6 • ST↑ in I, aVL(I >aVL)

  39. OM occlusion • Anterior and posterior part of lateral wall • Injury vector left and posteriorly • Upward or downward depending on area of invt. • Diagonal –upward and anteriorly

  40. OM occlusion

  41. Ecg pattern • Slight ST ↑ in I,aVL,V5−6 • Slight ST ↑ II, III,aVF may occur • Slight ST ↓ in V1−3

  42. Dominant LCX occlusion • Inferior lateral and inferobasalseg • Injury vector in frontal plane b/w +60 &+90,posteriorly

  43. Dominant LCX occlusion

  44. ECG pattern • ST↑ in II,III,aVF(II≥III) greater than ST ↓ in V1−3 • ST ↓ aVL usually not in I • Prominent ST ↑ in V5−6

More Related