Advanced ecg(1)

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djorgenmorris

medic

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Inferior Wall MI
• Most common
• Very lethal
• 50% have RV involvement
• Can also have 1st degree or 2nd degree type I
• Nausea
• Look for RVI with V4R, nitrates with caution..
• Fluids

Right Ventricular Infarction
• No Nitro
• No morphine
• Big preload problem
• 50% of Inferior wall MI have RV involvement

Septal and Lateral
• Rarely seen alone
• Usually an extension of anterior or inferior

Posterior Wall MI
• V8 and V9 show ST elevation
• Only 8% have reciprocal change in V1-V3

• S wave V1 + V5 (or V6) > 35mm
• R wave in aVL > 11mm

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Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)

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Advanced ecg(1)

1. MORE ECGS

3. Inferior Wall MI • Most common • Very lethal • 50% have RV involvement • Can also have 1st degree or 2nd degree type I • Nausea • Look for RVI with V4R, nitrates with caution.. • Fluids

5. Right Ventricular Infarction • No Nitro • No morphine • Big preload problem • 50% of Inferior wall MI have RV involvement

9. Septal and Lateral • Rarely seen alone • Usually an extension of anterior or inferior

10. Posterior MI

11.

12.

13.

14.

15. Posterior Wall MI • V8 and V9 show ST elevation • Only 8% have reciprocal change in V1-V3

16. Bundle Branch Blocks

17. Morphologies

18.

19. QS

20.

21. RsR’

22.

23. QS

24.

25. rSR’

26.

27. RsR’

28.

29. QS

30.

31. RsR’

32.

33. rSR’

34. Morphologies

35. Axis Deviation

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46. Left Vent. Hypertrophy

47. • S wave V1 + V5 (or V6) > 35mm • R wave in aVL > 11mm

48.

49.

50.

51. STEMI Imposters

52. Digitalis toxicity

53.

54.

55.

56.

57. Digitalis and Hyperkalemia

58. Pericarditis

59.

60.

61.

62. Early repolarization

63.

64.

65. Add V-Tach Criteria

Notas do Editor

normal

Advanced ecg(1)

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