14 ischemia injury & infarct1
TRANSCRIPT
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12-Lead 12-Lead ElectrocardiographyElectrocardiography
a comprehensive course
Adam Thompson, EMT-P, A.S.Adam Thompson, EMT-P, A.S.
Ischemia,
Injury, &
Infarct
(Part 1)
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The 6-Step MethodThe 6-Step Method
• 1. Rate & Rhythm1. Rate & Rhythm
• 2. Axis Determination2. Axis Determination
• 3. Intervals3. Intervals
• 4. Morphology4. Morphology
• 5. STE-Mimics5. STE-Mimics
• 6. 6. Ischemia, Injury, & InfarctIschemia, Injury, & Infarct
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STEMISTEMI
• STEMISTEMI– ST-Segment Elevated Myocardial InfarctionST-Segment Elevated Myocardial Infarction– ST-Segment Elevation of > 1mm in two contiguous ST-Segment Elevation of > 1mm in two contiguous
leads. leads. – In V2 & V3, ST-Segment elevation must be at least In V2 & V3, ST-Segment elevation must be at least
2mm.2mm.
*The smaller the QRS complex, the more significant minimal ST-*The smaller the QRS complex, the more significant minimal ST-
Elevation is.Elevation is.
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Objectives
• Learn how to identify a STEMI
• Learn how to localize the infarcted area
• Apply everything learned thus far
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What are Contiguous Leads?What are Contiguous Leads?
• Contiguous leads are leads that look at Contiguous leads are leads that look at the same area of the heart. the same area of the heart.
• They show up on the 12-lead proximal They show up on the 12-lead proximal to each other.to each other.
Lead I
lateral
aVR V1
septal
V4
anterior
Lead II
inferior
aVL
high lateral
V2
septal
V5
low lateral
Lead III
inferior
aVF
inferior
V3
anterior
V6
low lateral
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Coronary Circulation
Left Main
Circumflex(LCx)
Left Anterior Descending(LAD)
Right Coronary Artery(RCA)
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Coronary Circulation
Right Coronary Artery
(RCA)
Left Circumflex Artery
(LCx)
Left Anterior Descending
(LAD)
•Right Atrium•Inferior Wall•Inferior-Right Ventricle
•Posterior Wall - 85% of population
•Inferior Wall•Isolated Right Ventricle
•Posterior Wall - 15% of population
•Anterolateral•Inferolateral•Posterolateral
•Anterior•Anteroseptal•Anteroseptal-lateral
*Nicknamed “Widow-maker”
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Coronary Occlusion
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Heart Anatomy
Lateral Wall
Septal
Inferior
Anterior
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Heart Anatomy
Epicardium
Endocardium
Myocardium
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Ischemia, Injury, Infarct
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ST-Elevation
• The most common cause of ST-elevation is not myocardial infarction.
• Less than 50% of STEMI alerts called by paramedics are actually Acute Coronary Syndrome (ACS) patients
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ST-Elevation
• ST-Elevation is elevation of the J-Point which causes elevation of the following ST-Segment.
• Elevation is defined as anything above the isoelectric line.
• Find the isoelectric line by locating the TP-Segment.
T P
TP-Segment
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ST-Elevation
• The J-Point is where the QRS complex and the ST-Segment meet.J-Point
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ST-Segment Morphology
Concave Convex
J-Point J-Point
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Part 1
• More up next…