Other territories Inferior MI – can have RV involvement ◦ RV leads - V4R Posterior MI – Usually ST depression V1- V3
The hallmark of acute ischaemia is ST segment shift ST elevation = complete blockage = STEMI ST depression = partial blockage = NSTEMI/USA Generally only occurs when patient has symptoms: ACS are dynamic If real, usually have changes in contiguous leads
STEMI Occluded coronary artery Emergency = myocardium is dying!
STEMI Changes evolve: ◦ Often “hyperacute” T waves initially ◦ T wave inversion ◦ Q waves Dynamic - repeat ECGs if not sure What territory is it? ◦ Two contiguous leads ◦ Can get reciprocal ST depression ◦ Remember posterior & RV involvement
Differential Pericarditis ◦ Widespread concave upsloping ST depression ◦ Would involve multiple coronary arteries if MI ◦ PR depression (II) ◦ Look at the patient – common sense
Management of STEMI ABC Cardiac monitor (can go into VF) Analgesia Aspirin Clopidogrel Reperfusion therapy ◦ Thrombolysis ◦ Primary PCI Medical Rx
Inferior Lateral Septal Anterior
Old MIs Old STEMIs can leave permanent Q waves Territories are the same (anterior, inferior lateral etc.) Poor R wave progression can also indicate an old anterior STEMI
Often get T wave inversion as well Remember your territories Generally ST depression only occurs during acute ischaemia Differential ◦ Digoxin (downsloping lateral: V4-V6, I, aVL) ◦ LVH (downsloping lateral)
Management of NSTEMI/USA ABC Cardiac monitor Analgesia Initial medical Rx ◦ Aspirin ◦ Clopidogrel ◦ Beta-blocker ◦ Statin ◦ LMWH IP angiography
Question 1 What are the ECG abnormalities? What is the differential?
Question 2 What are the ECG abnormalities? What sort of ACS? What territory is affected?
Question 3 What are the ECG abnormalities What sort of ACS? What territory?
Question 4 What are the ECG abnormalities? Give 3 possible differentials
Question 5 What are the ECG abnormalities? What sort of ACS? What territory?