12Other territories Inferior MI – can have RV involvement RV leads - V4RPosterior MI – Usually ST depression V1- V3
13The hallmark of acute ischaemia is ST segment shift ST elevation = complete blockage = STEMIST depression = partial blockage = NSTEMI/USAGenerally only occurs when patient has symptoms: ACS are dynamicIf real, usually have changes in contiguous leads
15STEMIOccluded coronary arteryEmergency = myocardium is dying!
16STEMI Changes evolve: Dynamic - repeat ECGs if not sure Often “hyperacute” T waves initiallyT wave inversionQ wavesDynamic - repeat ECGs if not sureWhat territory is it?Two contiguous leadsCan get reciprocal ST depressionRemember posterior & RV involvement
17Differential Pericarditis Widespread concave upsloping ST depression Would involve multiple coronary arteries if MIPR depression (II)Look at the patient – common sense
18Management of STEMI ABC Cardiac monitor (can go into VF) Analgesia AspirinClopidogrelReperfusion therapyThrombolysisPrimary PCIMedical Rx
26ST depression Often get T wave inversion as well Remember your territoriesGenerally ST depression only occurs during acute ischaemiaDifferentialDigoxin (downsloping lateral: V4-V6, I, aVL)LVH (downsloping lateral)