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12-Lead 12-Lead ElectrocardiographyElectrocardiography
a comprehensive course
Adam Thompson, EMT-P, A.S.Adam Thompson, EMT-P, A.S.
Ischemia,
Injury, &
Infarct
(Part 1)
The 6-Step MethodThe 6-Step Method
• 1. Rate & Rhythm1. Rate & Rhythm
• 2. Axis Determination2. Axis Determination
• 3. Intervals3. Intervals
• 4. Morphology4. Morphology
• 5. STE-Mimics5. STE-Mimics
• 6. 6. Ischemia, Injury, & InfarctIschemia, Injury, & Infarct
STEMISTEMI
• STEMISTEMI– ST-Segment Elevated Myocardial InfarctionST-Segment Elevated Myocardial Infarction– ST-Segment Elevation of > 1mm in two contiguous ST-Segment Elevation of > 1mm in two contiguous
leads. leads. – In V2 & V3, ST-Segment elevation must be at least In V2 & V3, ST-Segment elevation must be at least
2mm.2mm.
*The smaller the QRS complex, the more significant minimal ST-*The smaller the QRS complex, the more significant minimal ST-
Elevation is.Elevation is.
Objectives
• Learn how to identify a STEMI
• Learn how to localize the infarcted area
• Apply everything learned thus far
What are Contiguous Leads?What are Contiguous Leads?
• Contiguous leads are leads that look at Contiguous leads are leads that look at the same area of the heart. the same area of the heart.
• They show up on the 12-lead proximal They show up on the 12-lead proximal to each other.to each other.
Lead I
lateral
aVR V1
septal
V4
anterior
Lead II
inferior
aVL
high lateral
V2
septal
V5
low lateral
Lead III
inferior
aVF
inferior
V3
anterior
V6
low lateral
Coronary Circulation
Left Main
Circumflex(LCx)
Left Anterior Descending(LAD)
Right Coronary Artery(RCA)
Coronary Circulation
Right Coronary Artery
(RCA)
Left Circumflex Artery
(LCx)
Left Anterior Descending
(LAD)
•Right Atrium•Inferior Wall•Inferior-Right Ventricle
•Posterior Wall - 85% of population
•Inferior Wall•Isolated Right Ventricle
•Posterior Wall - 15% of population
•Anterolateral•Inferolateral•Posterolateral
•Anterior•Anteroseptal•Anteroseptal-lateral
*Nicknamed “Widow-maker”
Coronary Occlusion
Heart Anatomy
Lateral Wall
Septal
Inferior
Anterior
Heart Anatomy
Epicardium
Endocardium
Myocardium
Ischemia, Injury, Infarct
ST-Elevation
• The most common cause of ST-elevation is not myocardial infarction.
• Less than 50% of STEMI alerts called by paramedics are actually Acute Coronary Syndrome (ACS) patients
ST-Elevation
• ST-Elevation is elevation of the J-Point which causes elevation of the following ST-Segment.
• Elevation is defined as anything above the isoelectric line.
• Find the isoelectric line by locating the TP-Segment.
T P
TP-Segment
ST-Elevation
• The J-Point is where the QRS complex and the ST-Segment meet.J-Point
ST-Segment Morphology
Concave Convex
J-Point J-Point
Part 1
• More up next…
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