the 12 lead ecg in acute coronary syndromes
DESCRIPTION
The 12 Lead ECG in Acute Coronary Syndromes. Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services. Sponsored by:. 12-Lead ECG in ACS Course. Module I Essential Interpretation Module II Acquisition & Transmission Module III Acute Coronary Syndromes Part 1 - PowerPoint PPT PresentationTRANSCRIPT
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Eric Lynn NREMT-P
Clinical Education SpecialistAmarillo Medical Services
The
12 Lead ECGin Acute Coronary Syndromes
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Sponsored by:
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12-Lead ECG in ACS Course
Module I Essential InterpretationModule II Acquisition & TransmissionModule III Acute Coronary Syndromes Part
1Module IV Acute Coronary Syndromes Part
2Module V The High Acuity PatientModule VI Bundle Branch Block & the ACS
Imitators
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Essential 12-Lead Interpretation
MODULE 1MODULE 1
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Essential 12-Lead ECG Interpretation
GoalsRecognize and localize AMI on
the 12-Lead ECGFeel comfortable with 12-lead
interpretation
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12-Lead ECG
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12-Lead ECG
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12-Lead ECG
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12-Lead ECG
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12-Lead ECG
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12-lead ECG
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12-Lead ECG
80 milliseconds = 0.08 seconds
0.080 080.0
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12-Lead ECG
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R Wave
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Q Wave
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S Wave
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QRS
Q wavesPhysiologic Q waves
< .04 sec (40ms)Pathologic Q
>.04 sec (40 ms)
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QRS
Q wave
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QS Complex
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J-Point
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ST Segment
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Practice
Find J-points and ST segments
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Practice
Find J-points and ST segments
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ST Segment
Compare to TP segment
ST TP
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ST Segment Analysis
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12-Lead ECG
AMI recognitionTwo things to know
What to look forWhere you are looking
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AMI Recognition
What to look forST segment elevation
One millimeter or more (one small box)
Present in two anatomically contiguous leads
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ST Segment Elevation
Presumptive evidence of AMI
Indication for acute reperfusion therapy
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Practice
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Lead “Views”
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Limb Leads Chest Leads
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Lead Groups
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Lead “Views”
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Anatomical Position
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Inferior Wall
II, III, aVFLeft Leg
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Inferior Wall
Inferior Wall
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Lateral WallI and aVL
Left Arm
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Lateral WallV5 and V6
Left lateral chest
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Lateral
I, aVL, V5, V6
Lateral Wall
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Anterior WallV3, V4
Left anterior chest
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Anterior Wall
• V3, V4V3, V4
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Septal WallV1, V2Along sternal borders
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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Septal
• V1,V2V1,V2
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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AMI Localization
Anterior: Anterior: V3, V4V3, V4Septal: Septal: V1, V2V1, V2Inferior: Inferior: II, III, AVFII, III, AVFLateral:Lateral: I, AVL, V5, V6I, AVL, V5, V6
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
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AMI Recognition
I Lateral
II Inferior
III Inferior
aVR
aVL Lateral
V1 Septal
aVF Inferior
V2 Septal
V3 Anterior
V4 Anterior
V5 Lateral
V6 Lateral
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AMI Recognition
Know what to look forST elevation> 1mmTwo contiguous leads
Know where you are lookingUse pocket card as a referenceYou will soon have this memorized
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Practice
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Practice
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Evolution of AMI
• HyperacuteHyperacute
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Evolution of AMI
• AcuteAcute
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Evolution of AMI
• AcuteAcute
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Evolution of AMI
• Age undeterminedAge undetermined
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AMI Recognition
A normal 12-lead ECG DOES NOT rule out AMI
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Practice
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Practice
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Practice
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Reciprocal Changes
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Reciprocal Changes
II, III, aVFII, III, aVF I, aVL, V leadsI, aVL, V leads
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Practice
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Practice
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AMI Recognition
Reciprocal changesNot necessary to presume
infarctionStrong confirming
evidence when present
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AMI Recognition
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AMI Recognition
Imitators of infarctLVHBBBVentricular beatsPericarditisEarly RepolarizationOthers
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Summary
AMI recognitionKnow what you are looking for
1mm of ST elevationTwo contiguous leads
Know where you are lookingPositive electrode as an “eye”Pocket card
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Summary
Reciprocal changesNot necessary to presume
infarctionStrong confirming
evidence when present
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Summary
ST segment elevation is presumptive evidence for AMI
Other conditions may also cause ST elevation
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Summary
A normal 12-Lead ECG DOES NOT rule out AMI
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ACS
AMI is part of a spectrum of
disease know as the
Acute Coronary SyndromesAcute Coronary Syndromes