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ECG in Acute Myocardial infarction &  culprit artery localisation Dr.Nagaraj Moorthy SJIC 04-04-08
Introduction   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction   ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
ECG changes in AMI ,[object Object],[object Object],[object Object],[object Object]
ECG manifestations of AMI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG changes associated with Prior MI ,[object Object],[object Object],[object Object],[object Object]
Re infarction by ECG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AMI-Early Hyperacute Phase ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Hyperacute T waves
Grading of ischemia- Sclarrovsky Birnbaum
 
 
 
Reciprocal and Indicative Changes
 
Early repolarisation pattern
Pericarditis
L V aneurysm
Hypertrophic cardiomyopathy
Reciprocal ST segment depression
Chronic Stable MI
Resolution of changes in ST segment and T waves
RVMI
Posterior wall MI
Ischemia and Infarction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transmural and subendocardial MI Q-MI does not always correlate with  transmural MI Non-Q-MI does not always correlate with  subendocardial MI
Q-wave Myocardial Infarction (1) ,[object Object],[object Object],[object Object]
Sampling through electrically  “ silent” area into the cavity. In the cavity, all initial wavefronts are directed away   Q wave Transmural Injury   Q wave
Q-wave Myocardial Infarction (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Regions of the Myocardium Inferior II, III, aVF Lateral I, AVL,  V5-V6 Anterior /  Septal V1-V4
 
Posterior wall MI ,[object Object],[object Object],[object Object]
Posterior Myocardial Infarction recent or probably acute ,[object Object],[object Object],[object Object],[object Object]
RVMI ,[object Object],[object Object],[object Object],[object Object]
Localisation of culprit vessel in AMI
[object Object],[object Object],[object Object]
Coronary Artery Circulation
Coronary Artery Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Coronary Artery Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Lesions in LAD D1 S1 D1
Proximal LAD
Terminology ,[object Object],[object Object],[object Object]
 
 
 
 
Proximal LAD before S1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proximal to D1
 
Proximal to D1 ,[object Object],[object Object],[object Object]
Distal LAD
Distal to D1 ,[object Object],[object Object]
 
 
 
Localisation in IWMI
Right coronary artery ,[object Object],[object Object],[object Object],[object Object]
Left circumflex artery ,[object Object],[object Object],[object Object],[object Object]
Value RV4
 
 
 
 
 
 
 
AMI with LBBB ,[object Object]
LBBB with MI
 
Sgarbossa’s criteria ,[object Object],[object Object]
 
 
LBBB with AMI
WELLEN’S SYNDROME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WELLEN’S SYNDROME
WELLEN’S SYNDROME
? RVMI
?RVMI
Localisation of culprit vessel ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FACTORS THAT DETERMINE PROGNOSIS IN ACUTE MYOCARDIAL INFARCTION ,[object Object]
 
ESTIMATION OF THE SIZE OF THE ISCHAEMIC MYOCARDIUM AT RISK ,[object Object],[object Object],[object Object],[object Object],[object Object]
ESTIMATION OF THE SIZE OF THE ISCHAEMIC MYOCARDIUM AT RISK ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object]
ECG Predictors of Reperfusion   ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Arrhythmias and Conduction Disease in AMI   ,[object Object]
 
Inferior Myocardial Infarction   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anterior Myocardial Infarction   ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Post MI Risk Stratification Role of Electrocardiogram
At The Time of Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Stratification after MI by ECG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References :  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU

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Ecg in AMI

Notas del editor

  1. Terms transmural and non-transmural MI are appropriate only for pathological studies. Q-MI on ECG do not correspond with transmural MI and non-Q-MI do not correspond with subendocardial MI. That is why we advise to use terms Q-MI and Non-Q-MI to describe ECGs.
  2. Myocardial necrosis consist mainly of electrically inert tissue (loss of electrical potential). Dominant electrical forces will be forces of the opposite wall (directed to the opposite direction) and that is why the overlying electrodes inscribe negative initial deflection (Q wave). If the size of MI is small, reduction of R wave is occur instead of Q wave.
  3. First part of this slide contains the definition of pathological Q wave. However, Q wave is not pathological if it is confined only to lead III or to lead aVL. When the Q wave is inscribed in leads V1 and V2, Q-MI cannot be excluded but many other abnormalities can cause the same pattern.