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Essential 12-Lead Interpretation MODULE 1. Essential 12-Lead ECG Interpretation GoalsGoals –Recognize and localize AMI on the ECG –Feel comfortable with.

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Presentation on theme: "Essential 12-Lead Interpretation MODULE 1. Essential 12-Lead ECG Interpretation GoalsGoals –Recognize and localize AMI on the ECG –Feel comfortable with."— Presentation transcript:

1 Essential 12-Lead Interpretation MODULE 1

2 Essential 12-Lead ECG Interpretation GoalsGoals –Recognize and localize AMI on the ECG –Feel comfortable with 12-lead interpretation

3 12-Lead ECG

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5

6

7 12-lead ECG

8 12-Lead ECG 80 milliseconds = 0.08 seconds

9 12-Lead ECG

10 R Wave

11 Q Wave

12 S Wave

13 QRS Q wavesQ waves –Physiologic Q waves <.04 sec (40ms)<.04 sec (40ms) –Pathologic Q >.04 sec (40 ms)>.04 sec (40 ms)

14 QRS Q waveQ wave

15 QS Complex

16 J-Point

17 ST Segment

18 Practice Find J-points and ST segmentsFind J-points and ST segments

19 Practice

20 ST Segment Compare to TP segmentCompare to TP segment STTP

21 ST Segment Analysis

22 12-Lead ECG AMI recognitionAMI recognition –Two things to know What to look forWhat to look for Where you are lookingWhere you are looking

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

24 ST Segment Elevation Presumptive evidence of AMIPresumptive evidence of AMI Indication for acute reperfusion therapyIndication for acute reperfusion therapy

25 Practice

26 Lead Views

27 Limb LeadsChest Leads IaVRV1V4 IIaVLV2V5 IIIaVFV3V6 Lead Groups

28 Lead Views

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

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

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

32 Lateral Wall V5 and V6V5 and V6 –Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

33 Lateral Lateral Wall I, aVL, V5, V6I, aVL, V5, V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

34 Anterior Wall V3, V4V3, V4 –Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

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

36 Septal Wall V1, V2V1, V2 Along sternal bordersAlong sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

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

38 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

39 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

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

41 Practice

42 Practice

43 Evolution of AMI HyperacuteHyperacute

44 Evolution of AMI AcuteAcute

45 Evolution of AMI AcuteAcute

46 Evolution of AMI Age undeterminedAge undetermined

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

48 Practice

49 Practice

50 Practice

51 Reciprocal Changes

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

53 Practice

54 Practice

55 AMI Recognition Reciprocal changesReciprocal changes –Not necessary to presume infarction –Strong confirming evidence when present

56 AMI Recognition

57 Imitators of infarctImitators of infarct –LVH –BBB –Ventricular beats –Pericarditis –Early Repolarization –Others

58 Summary AMI recognitionAMI recognition –Know what you are looking for 1mm of ST elevation1mm of ST elevation Two contiguous leadsTwo contiguous leads –Know where you are looking Positive electrode as an eyePositive electrode as an eye Pocket cardPocket card

59 Summary Reciprocal changesReciprocal changes –Not necessary to presume infarction –Strong confirming evidence when present

60 Summary ST segment elevation is presumptive evidence for AMIST segment elevation is presumptive evidence for AMI Other conditions may also cause ST elevationOther conditions may also cause ST elevation

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

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


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