ECG – Acute Coronary syndromes EMC SDMH 2015

ECG 1

The J point

Benign Early Repolarisation

ECG 2

ECG 3

ECG 4

ECG 5

RV infarction V1 elevation with inferior changes. Confirm with presence STE in lead V4R

ECG 6

Reciprocal changes STE will cause ‘injury current’ pattern (STD) on opposite of heart due to change in electrical vector NOT due to subendocardial ischemia If deep ST depression noted, consider STE in opposite side of heart Remember ‘PAIL’ Posterior reciprocates to Anterior  Inferior  Lateral. If not fitting this, consider further territory infarction

?Posterior STEMI

Posterior STEMI Investigate with Posterior leads. Only require 0.5mm to diagnose STE in Post. leads

ECG 6

LMCA Disease Look for STE in aVR – ‘the forgotten lead’ – in setting of chest pain >1mm STE OR; ST in aVR>V1 highly specific for Left main or severe 3VD If occluded, high risk for cardiogenic shock May require emergent CABG; consult before giving clopidogrel May also been seen in tachyarrythmias, post-arrest, and TCA overdose

LMCA

ECG 7

Wellen syndrome Specific for high LAD lesion Pt should not undergo EST!!! 2 patterns – Type A and B

ECG 8

Sgarbossa Criteria – STEMI in LBBB/Paced rhythm STE concordance >1mm in contiguous leads (5 points) STD concordance >1mm in V1-3 (3 points) ST Discordance >5 mm in contiguous leads (2 points) Score >3 = 90% specific for diagnosis STEMI in LBBB