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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
KIMS, Kollam
India
editor
DIAGNOSIS
ECG
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| CHARACTERISTICS |
STEMI | ST elevation | ST elevation in 2 or more contiguous leads. J point elevation greater than 2mm in V2,V3* & 1mm or more other leads.
*: males <40 yrs 2.5 mm ; females 1.5mm |
High risk UA/NSTEMI | ST depression or dynamic T-wave inversion | ST segment depression ≥0.5mm or dynamic T- wave inversion with pain or discomfort. Non persistent or transient ST elevation for <20 min .
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Intermediate or low risk UA | Normal or non diagnostic ECG | Non specific ST/T changes |
Q waves and Territory Involved
Anteroseptal | QS deflections in V1,V2,V3 & possibly V4 |
Anterior | rS deflection in v1 with Q waves in V2-V4 or decrease in amplitude of initial R wave in V1-V4. |
Anterolateral | Q waves in V4-V6,I & aVL |
Lateral | Q waves in I & aVL |
Inferior | Q waves in II,III, aVF |
Inferolateral | Q waves in II,III,aVF ,V5,V6 |
True posterior | Tall R waves in V1 & V2; R/S ratio ≥1 with ST depression |
Right ventricular | Q waves in II,III & aVF & ST elevation in right side V4. |
In inferior wall MI always take a right side chest leads so as to look for an right ventricluar infraction. This is because autopsy studies on patients with an inferiopposterior infract found that one out of four cases had involenement of right ventricles.
POINTS TO REMEMBER
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POINTS TO REMEMBER
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What is J point ?
It is the junction of QRS complex and ST segment.
ST SEGMENT DEPRESSION
ST segment depression usually represents subendocardial ischemia.
A horizontal or downward ST depression of at least 1mm or more lasting 0.08 sec as a positive result.
ST segment depression with a rapid upward sloping of st segment are considered negative.
POINTS TO REMEMBER
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Updated on 24/8/13
Reference :
Goldberger
ECG Made Easy by John Hampton
Tintinalli
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
KIMS, Kollam
India
editor