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Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services The 12 Lead ECG in Acute Coronary Syndromes.

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Presentation on theme: "Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services The 12 Lead ECG in Acute Coronary Syndromes."— Presentation transcript:

1 Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services The 12 Lead ECG in Acute Coronary Syndromes

2 Sponsored by:

3 12-Lead ECG in ACS Course Module I Essential Interpretation Module II Acquisition & Transmission Module III Acute Coronary Syndromes Part 1 Module IV Acute Coronary Syndromes Part 2 Module V The High Acuity Patient Module VI Bundle Branch Block & the ACS Imitators

4 Essential 12-Lead Interpretation MODULE 1

5 Essential 12-Lead ECG Interpretation Goals Recognize and localize AMI on the 12-Lead ECG Feel comfortable with 12-lead interpretation

6 12-Lead ECG

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11 12-lead ECG

12 12-Lead ECG 80 milliseconds = 0.08 seconds 0.080 080.0

13 12-Lead ECG

14 R Wave

15 Q Wave

16 S Wave

17 QRS Q waves Physiologic Q waves <.04 sec (40ms) Pathologic Q >.04 sec (40 ms)

18 QRS Q wave

19 QS Complex

20 J-Point

21 ST Segment

22 Practice Find J-points and ST segments

23 Practice Find J-points and ST segments

24 ST Segment Compare to TP segment STTP

25 ST Segment Analysis

26 12-Lead ECG AMI recognition Two things to know What to look for Where you are looking

27 AMI Recognition What to look for ST segment elevation One millimeter or more (one small box) Present in two anatomically contiguous leads

28 ST Segment Elevation Presumptive evidence of AMI Indication for acute reperfusion therapy

29 Practice

30 Lead Views

31 Limb LeadsChest Leads IaVRV1V4 IIaVLV2V5 IIIaVFV3V6 Lead Groups

32 Lead Views

33 Anatomical Position

34 Inferior Wall II, III, aVF Left Leg I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

35 Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

36 Lateral Wall I and aVL Left Arm I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

37 Lateral Wall V5 and V6 Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

38 Lateral I, aVL, V5, V6 Lateral Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

39 Anterior Wall V3, V4 Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

40 Anterior Wall V3, V4V3, V4 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

41 Septal Wall V1, V2 Along sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

42 Septal V1,V2V1,V2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

43 AMI Localization Anterior: V3, V4 Septal: V1, V2 Inferior: II, III, AVF Lateral:I, AVL, V5, V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

44 AMI Recognition I Lateral II Inferior III Inferior aVR aVL Lateral V1 Septal aVF Inferior V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral

45 AMI Recognition Know what to look for ST elevation > 1mm Two contiguous leads Know where you are looking Use pocket card as a reference You will soon have this memorized

46 Practice

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48 Evolution of AMI HyperacuteHyperacute

49 Evolution of AMI AcuteAcute

50 Evolution of AMI AcuteAcute

51 Evolution of AMI Age undeterminedAge undetermined

52 AMI Recognition A normal 12-lead ECG DOES NOT rule out AMI

53 Practice

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56 Reciprocal Changes

57 II, III, aVF I, aVL, V leads

58 Practice

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60 AMI Recognition Reciprocal changes Not necessary to presume infarction Strong confirming evidence when present

61 AMI Recognition

62 Imitators of infarct LVH BBB Ventricular beats Pericarditis Early Repolarization Others

63 Summary AMI recognition Know what you are looking for 1mm of ST elevation Two contiguous leads Know where you are looking Positive electrode as an eye Pocket card

64 Summary Reciprocal changes Not necessary to presume infarction Strong confirming evidence when present

65 Summary ST segment elevation is presumptive evidence for AMI Other conditions may also cause ST elevation

66 Summary A normal 12-Lead ECG DOES NOT rule out AMI

67 ACS AMI is part of a spectrum of disease know as the Acute Coronary Syndromes


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