E.C.G. Course – IV ST – T Deviations and QT prolongation Dr. Michael Kassirer ”Dept. Internal Medicine ”D Tel-Aviv Medical center
Objective By the end of lesson 4 the student will:
Be able to diagnose ST segment elevation, identify and locate AMI, and other causes of ST segment elevation.
Describe the sequence of ECG events in AMI
Know how to diagnose ST depression.
Understand the importance of T wave inversion
ECG changes in CHD summery
T wave inversion – Ischemia ST deviation: – Elevation – Injury (trans-mural) - Depression – Ischemia (Subendocardial). - Reciprocal changes QRS: – decreased R - Q wave
Infarct Infarct
Injury
Ischemia
The QRS complex – V. depolarization
V1
V6
L3
L2
The QRS complex – V. depolarization
V1 V1
L3
V6
L2
The QRS complex – V. depolarization
V1 V1
L3
V6
L2
The QRS complex – V. depolarization
V1 V1
V6
L3 L3
L2
ST changes in Ischemia ))Phase 2 changes Injur y
V1
L3
Ischemia
V6
L2
V1
L3
V6
L2
AMI – ECG evolution
ST elevation and MI location ST ↑ in leads…Position Occ. Artery V1-3 Anterior LAD Septal/Apical mid LAD V2-4 LCx or D1/M1 V5-6 (± L1, aVL) Lateral Ext. Antrior L.M or Prox. LAD V1-6 Inferior (RCA (80% L2, L3, aVF High lateral M1 or D1 L1, aVL Posterior LCx V7-9 RV RCA V2R-4R
?Where is the MI
?Where is the MI
?Where was the MI
ST elevation – non AMI
arly repolarization
Pericarditis
ST elevation – non AMI
L.B.B.B
Hyperkalemia
ST - T depression
T wave inversion
Evolving MI/NSTEMI Old MI Myocarditis LVH/RVH strain Cerebral T wave
T wave inversion
LVH/RVH + Strain
Digitalis effect