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Essential 12-Lead Interpretation

MODULE 1. Essential 12-Lead Interpretation. Essential 12-Lead ECG Interpretation. Goals Recognize and localize AMI on the ECG Feel comfortable with 12-lead interpretation. 12-Lead ECG. 12-Lead ECG. 12-Lead ECG. 12-Lead ECG. 12-lead ECG. 12-Lead ECG. 080.0. 0.080.

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Essential 12-Lead Interpretation

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  1. MODULE 1 Essential 12-Lead Interpretation

  2. Essential 12-Lead ECG Interpretation • Goals • Recognize and localize AMI on the ECG • Feel comfortable with 12-lead interpretation

  3. 12-Lead ECG

  4. 12-Lead ECG

  5. 12-Lead ECG

  6. 12-Lead ECG

  7. 12-lead ECG

  8. 12-Lead ECG 080.0 0.080 80 milliseconds = 0.08 seconds

  9. 12-Lead ECG

  10. R Wave

  11. Q Wave

  12. S Wave

  13. QRS • Q waves • Physiologic Q waves • < .04 sec (40ms) • Pathologic Q • >.04 sec (40 ms)

  14. QRS • Q wave

  15. QS Complex

  16. J-Point

  17. ST Segment

  18. Practice • Find J-points and ST segments

  19. Practice • Find J-points and ST segments

  20. ST Segment • Compare to TP segment ST TP

  21. ST Segment Analysis

  22. 12-Lead ECG • AMI recognition • Two things to know • What to look for • Where you are looking

  23. AMI Recognition • What to look for • ST segment elevation • One millimeter or more (one small box) • Present in two anatomically contiguous leads

  24. ST Segment Elevation • Presumptive evidence of AMI • Indication for acute reperfusion therapy

  25. Practice

  26. Lead “Views”

  27. Lead Groups I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Limb Leads Chest Leads

  28. Lead “Views”

  29. Inferior Wall • II, III, aVF • Left Leg I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  30. Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Inferior Wall

  31. Lateral Wall • I and aVL • Left Arm I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  32. Lateral Wall • V5 and V6 • Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  33. I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral • I, aVL, V5, V6 Lateral Wall

  34. Anterior Wall • V3, V4 • Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  35. Anterior Wall • V3, V4 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  36. Septal Wall • V1, V2 • Along sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  37. Septal • V1,V2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  38. I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 AMI Localization Anterior: V3, V4 Septal: V1, V2 Inferior: II, III, AVF Lateral: I, AVL, V5, V6

  39. AMI Recognition I Lateral aVR V1 Septal V4 Anterior II Inferior aVL Lateral V2 Septal V5 Lateral III Inferior aVF Inferior V3 Anterior V6 Lateral

  40. Know what to look for ST elevation > 1mm Two contiguous leads Know where you are looking Use pocket card as a reference You will soon have this memorized AMI Recognition

  41. Practice

  42. Practice

  43. Evolution of AMI • Hyperacute

  44. Evolution of AMI • Acute

  45. Evolution of AMI • Acute

  46. Evolution of AMI • Age undetermined

  47. AMI Recognition A normal 12-lead ECG DOES NOT rule out AMI

  48. Practice

  49. Practice

  50. Practice

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