1 / 33

ECG interpretation for beginners Part 4 – Acute coronary syndromes

ECG interpretation for beginners Part 4 – Acute coronary syndromes. Paul Williams Cardiology Specialist Registrar. Normal ECG!. MI diagnosis. Use your system Don’t forget rate, rhythm etc. Need to have basic understanding of: Pathology of heart attacks

lalo
Download Presentation

ECG interpretation for beginners Part 4 – Acute coronary syndromes

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 interpretation for beginnersPart 4 – Acute coronary syndromes Paul Williams Cardiology Specialist Registrar

  2. Normal ECG!

  3. MI diagnosis • Use your system • Don’t forget rate, rhythm etc. • Need to have basic understanding of: • Pathology of heart attacks • Coronary arteries and regions of heart

  4. Coronary arteries • 2 coronary arteries come off aorta • Total of 3 main coronary arteries • LCA • LMS branches into: • Left anterior descending (LAD) • Circumflex (Cx) • RCA

  5. Left ventricle supply • LAD – Supplies anterior wall, septum +- lateral walls(60%) • Cx – Supplies lateral wall (15%) • RCA – Supplies inferior and posterior walls (25%). Also supplies RV & conducting tisse

  6. Septal Lateral Anterior Lateral Inferior

  7. Other territories • Inferior MI – can have RV involvement • RV leads - V4R • Posterior MI – Usually ST depression V1-V3

  8. The hallmark of acute ischaemia is ST segment shift • ST elevation = complete blockage = STEMI • ST depression = partial blockage = NSTEMI/USA • Generally only occurs when patient has symptoms: ACS are dynamic • If real, usually have changes in contiguous leads

  9. STEMI • Occluded coronary artery • Emergency = myocardium is dying!

  10. STEMI • Changes evolve: • Often “hyperacute” T waves initially • T wave inversion • Q waves • Dynamic - repeat ECGs if not sure • What territory is it? • Two contiguous leads • Can get reciprocal ST depression • Remember posterior & RV involvement

  11. Differential • Pericarditis • Widespread concave upsloping ST depression • Would involve multiple coronary arteries if MI • PR depression (II) • Look at the patient – common sense

  12. Management of STEMI • ABC • Cardiac monitor (can go into VF) • Analgesia • Aspirin • Clopidogrel • Reperfusion therapy • Thrombolysis • Primary PCI • Medical Rx

  13. Septal Lateral Anterior Lateral Inferior

  14. Old MIs • Old STEMIs can leave permanent Q waves • Territories are the same (anterior, inferior lateral etc.) • Poor R wave progression can also indicate an old anterior STEMI

  15. ST depression

  16. ST depression • Often get T wave inversion as well • Remember your territories • Generally ST depression only occurs during acute ischaemia • Differential • Digoxin (downsloping lateral: V4-V6, I, aVL) • LVH (downsloping lateral)

  17. Management of NSTEMI/USA • ABC • Cardiac monitor • Analgesia • Initial medical Rx • Aspirin • Clopidogrel • Beta-blocker • Statin • LMWH • IP angiography

  18. Question 1 • What are the ECG abnormalities? • What is the differential?

  19. Question 2 • What are the ECG abnormalities? • What sort of ACS? • What territory is affected?

  20. Question 3 • What are the ECG abnormalities • What sort of ACS? • What territory?

  21. Question 4 • What are the ECG abnormalities? • Give 3 possible differentials

  22. Question 5 • What are the ECG abnormalities? • What sort of ACS? • What territory?

More Related