ECG interpretation in NSTEMI
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The document discusses ECG interpretation focusing on STEMI, its patterns, and the significance of rapid recognition for effective treatment. It outlines different ECG abnormalities associated with STEMI, including ST elevation indicating coronary artery occlusion and variations seen in left bundle branch blocks and posterior infarcts. The key takeaway is the importance of assessing clinical presentation and ECG details to minimize misdiagnosis and improve patient outcomes.
ECG interpretation in NSTEMI
- 1. ECG interpretation: STEMI Primary PCI and direct admission of high risk NSTEMI Joanne Simpson Golden Jubilee National Hospital Wednesday 17th February 2016
- 2. Aims Revise the ECG patterns which occur in STEMI Focus on those which are more difficult to recognise, but not uncommon Remember: Some ECG patterns are not clear cut Minimising missed STEMIs is the priority
- 3. 1. What does this ECG show?
- 4. 1. What does this ECG show? Anterior ST depression Left ventricular hypertrophy Bundle branch block Inferior STEMI
- 5. 2. What does this ECG show?
- 6. 2. What does this ECG show? Inferior T wave inversion Lateral T wave inversion Inferolateral T wave inversion High lateral STEMI
- 7. 3. What does this ECG show?
- 8. 3. What does this ECG show? Left bundle branch block Anterior T wave inversion Posterior STEMI Atrial fibrillation
- 9. 4. What does this ECG show?
- 10. 4. What does this ECG show? Left bundle branch block Left ventricular hypertrophy Anterior STEMI Atrial fibrillation
- 11. STEMI ST elevation myocardial infarction (STEMI) Complete (or near complete) occlusion of a coronary artery → restriction of blood supply to heart muscle beyond This produces characteristic symptoms and ECG changes which allow: rapid recognition of STEMI prompt delivery of optimal reperfusion therapy → minimise infarct size, risk of future events, early and late mortality
- 12. STEMI ST elevation myocardial infarction (STEMI) Complete (or near complete) occlusion of a coronary artery → restriction of blood supply to heart muscle beyond This produces characteristic symptoms and ECG changes which allow: rapid recognition of STEMI prompt delivery of optimal reperfusion therapy → minimise infarct size, risk of future events, early and late mortality
- 14. Different ECG patterns in STEMI 1. ST elevation reflecting occlusion of a coronary artery 2. Posterior infarct 3. Left bundle branch block
- 15. 1. ST elevation reflecting occlusion of a coronary artery - ‘injury current’ between normal and necrotic Tissue - occurs in regional patterns 2. Posterior infarct 3. Left bundle branch block Different ECG patterns in STEMI
- 16. ST elevation due to coronary occlusion ECG leads over the territory of the occluded artery will show ST elevation as the injury current travels toward them ST elevation correlates to the territory of the occluded artery: Inferior = RCA / LCx Posterior = RCA / LCx Lateral = LCx Anteroseptal = LAD Circumflex artery (LCx) Left anterior descending artery (LAD) Right coronary artery (RCA)
- 17. How do ECG leads look at the heart?
- 18. How do ECG leads look at the heart? Chest leadsFrontal leads
- 19. Inferior leads Anterior leads Lateral leads How do ECG leads look at the heart?
- 20. Correlating ECG leads with vessel territory Inferior Lateral AnteriorInferior leads Anterior leads Lateral leads
- 21. ST elevation due to coronary occlusion ST elevation in anterior leads ‘Reciprocal’ ST depression in inferior leads
- 22. ST elevation in inferior leads Reciprocal ST depression in anterior leads ST elevation due to coronary occlusion
- 23. ST elevation due to coronary occlusion ST elevation in high lateral leads ‘Reciprocal’ ST depression in inferior leads
- 24. Different ECG patterns in STEMI 1. ST elevation reflecting occlusion of a coronary artery - ‘injury current’ between normal and necrotic tissue - occurs in regional patterns 2. Posterior infarct - location means ST elevation is not seen 3. Left bundle branch block
- 25. Posterior wall infarction Posterior infarct may be caused by RCA or LCx occlusion - often associated with inferior or lateral ST elevation Circumflex artery (LCx) Left anterior descending artery (LAD) Right coronary artery (RCA)
- 26. Posterior wall infarction No ECG leads ‘look’ directly at the posterior wall of the heart Anterior leads are directly opposite and will see the opposite of any current generated at the posterior wall posterior ST elevation= anterior ST depression
- 27. Posterior wall infarction ST depression in anterior leads Subtle ST elevation in inferior leads
- 28. Different ECG patterns in STEMI 1. ST elevation reflecting occlusion of a coronary artery - ‘injury current’ between normal and necrotic tissue - occurs in regional patterns 2. Posterior infarct - location means ST elevation is not seen 3. Left bundle branch block (LBBB) - if NEW can indicate infarction - if OLD can obscure ST elevation during an infarct
- 29. Left bundle branch block
- 30. Left bundle branch block QRS duration > 3 small squares Negative QRS across anterior leads with poor R wave progression Notched R wave in V6 V1 V6
- 31. Summary The clinical presentation is paramount Check each ECG territory in turn for ST elevation Look for ST depression - is this reciprocal change? - if anterior, could it be a posterior infarct? Check the QRS duration - if > 3 small squares, is there LBBB?