ecg
DESCRIPTION
explain ECGTRANSCRIPT
Action potential “AP”Electrocardiograph “ECG”
Hamad Emad Dhuhayr
CONTENTS
1.SOEPEL
2.AP
3.ECG
SUBJECT:
Presenting ComplaintAn 81 year-old Saudi male is admitting to hospital with worsening abdominal pain over the last 2-3 days.
There is no chest pain or dsyponea (shortness of breath), however she complains of nausea and vomiting.
Past Medical HistoryOn examination of the patient's history it appears that he has a history of hypertension, Type 2 Diabetes mellitus (formerly NIDDM), coronary artery disease status post myocardial infarction (CAD S/P MI) 5 years ago and chronic abdominal pain for the last 2 years without a clear reason.
SOEPEL
OBJECTIVE:
taking history, physical examination
VITAL SIGNS:
*Physical Examination38.8 CRR: 16/min78 bpm210/100 mm/Hg
SOEPEL
EVALUATION (DD):
Myocardiac infraction
Appendicitis
Peptic ulcer
PLAN: ECG , ckmp and troponin *i-t* blood test.
ELABORATION: surgical intervention
SOEPEL
LEARNING GOALS:
AP - ECG
SOEPEL
AP
Localization - Myocardial Infarct Localization ST elevation
Reciprocal ST depression
Coronary Artery
Anterior MI V1-V6 None LAD
Septal Mi
V1-V4, disappearance of septum Q in leads V5,V6
none LAD
Lateral MI I, aVL, V5, V6 II,III, aVF (inferior leads)
LCX
Inferior MI II, III, aVF I, aVL (lateral lead)RCA (80%) or LCX (20%)
Posterior MI V7, V8, V9 high R in V1-V3 with ST depression V1-V3 > 2mm (mirror view)
RCA or LCX
Right Ventricle MI V1, V4R I, aVL RCA
Atrial MI PTa in I,V5,V6 PTa in I,II, or III RCA
11
The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG).
Anterior Wall
V3, V4
• Left anterior chest
• Positive electrode on anterior chest
12
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Apr 12, 2023
Septal Wall V1, V2
◦ Along sternal borders◦ Look through right ventricle & see
septal wall
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
13Apr 12, 2023
Practice
14
Anteroseptal MIST elevations V1, V2, V3, V4
Apr 12, 2023January 2004
15
Lateral Wall I and aVL
◦ View from Left Arm ◦ lateral wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Apr 12, 2023January 2004
Lateral Wall
V5 and V6◦ Left lateral chest◦ lateral wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
16Apr 12, 2023
Lateral Wall
• I, aVL, V5, V6
• ST elevation suspect lateral wall injury
17
Lateral Wall
Apr 12, 2023
Lateral MI
18Apr 12, 2023
19
Inferior Wall
II, III, aVF◦ View from Left Leg ◦ inferior wall of left ventricle
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Apr 12, 2023
Inferior MI
20Apr 12, 2023
Posterior Leads
• Posterior leads V1, V2• Posterior Infarct with ST Depressions and/ tall R wave • RCA and/or LCX Artery
ST elevation in V7,V8,V9.• Understand Reciprocal changes• The posterior aspect of the heart
is viewed as a mirror image and therefore depressions versus elevations indicate MI• Rarely by itself usually in combo.
Dr. UZMA ANSARI 21Apr 12, 2023January 2004
Apr 12, 2023Dr. UZMA ANSARI 22
ECG 1. The ECG above belongs to a patient with stable angina pectoris. The patient complained of effort angina in the last 2
weeks. Coronary angiography was performed and then the patient was referred to coronary artery bypass graft operation
because of 3 vessel disease. ST segment flattening is one of the first signs of coronary ischemia and generally preceedes ST
segment depression.