an interesting ecg for discussion
TRANSCRIPT
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ECG OF THE WEEKPROF.DR.DHANDAPANI’S UNITBY-DR.ANIRUDH .J.SHETTY
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50 yr old patient francis came with the chief c/o -chest pain for 3 days -retrosternal in location -intermittent in nature -had 2 such episodes ,one lasting for half an hr
and the other for an hour -radiating to the arms
Past h/o –pt is a known case of HTN not a known DM/IHD
O/E- Pt. conscious oriented afebrile
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PR-80/MIN BP-110/80mmHg
CVS-S1S2 heard no murmurs
RS-NVBS heard
P/A-Soft
CNS- NFND
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Summary
Rate -100 / mt;
Sinus rhythm;
P wave- bifid p waves in lead 2 PR-o.12 secs
QRS axis –normal axis;
QRS duration -0.08 secs
ST depression with tall T waves in V2,V3
ST segment elevation in leads 1 , avL
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Impression
In the posterior leads ST elevation > 1 mm in V8
& V9 seen
leading on to the diagnosis of “ POSTERIOR WALL MI “
Since leads 1, avL also shows St elevation;
“ High lateral MI”
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•Trop T levels : 0.4 U (N - <0.1 U )
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PWMI15-20% of total incidence ,often
accompanied by Inferior or lateral wall MI;
Isolated PWMI only 3.3% ;
Necrosis of the dorsal infraatrial portion of the left
ventricle beneath the AV sulcus
Artery involved: commonly LCX less common is RCA
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Ecg criteria for PWMI (v 1 to v 3 )
•ST-segment depression (horizontal >> downsloping/upsloping)*
•Prominent R wave*
•R/S wave ratio >1.0 in lead V2
•Prominent, upright T wave*
•Combination of horizontal ST-segment depression with upright T wave*
•Co-existing acute inferior and/or lateral MI
•- Additional lead ECG (posterior leads V7 to V9)
≥ 1 mm ST-segment elevation
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DIFF.DIAG. OF TALL R WAVE IN RT.PRECORDIAL LEADS
• Diagnosis • True posterior infarct
----------
• Right ventricular hypertrophy-
• Rt.bundle branch block--------
• Wolff-parkinson white syndr.----
• Confirmatory clues • ST↓, T↑ in V1-V2; Q waves
and ST↑ V7 to V9
• RAD, RAE; secondary ST-Ts; V7 to V9 normal
• Wide QRS; broad S in V1, V6; R peaks late in V1; V7 to V9 normal or broad S waves
• Short PR; delta wave; V7 to V9 normal or delta wave
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COMPLICATIONS Ventricular aneurysm ,rupture with sudden
death is more common with posterior wall
myocardial infarction
Rupture of chordae tendinae leads to mitral valve
Incompetence
Rupture of septum carries a special danger with
increased mortality
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THANK
YOU