ECG: Interpreting ASMI

1. PROF DR.MAGESHKUMAR’S UNIT
DR.S.GEETHALAKSHMI

2. 35 Yr old MR. JAYAKUMAR Came with
•c/o retrosternal compressing chest pain
•2 hrs duration , Radiating to left arm
•Associated diaphoresis & palpitations +nt
•Smoker 15 yrs
•Alcoholic 10 yrs
•Not a k/c/o SHT / DM / CAD pt
•Examn fairly normal
•Vitals stable with a BP of 140 / 90 mm Hg

4. I
II
III

5. SHOWS
•RATE 100/min
•RHYTHM normal sinus rhythm
•P WAVE present with normal morphology
•PR INTERVAL 0.16 secs
•QRS DURATION normal
•QT INTERVAL 0.32 secs
•ST SEGMENT ELEVATION V1 – V4

6. DIAGNOSIS
•ANTERIOR WALL MI
what more from ecg ?what more from ecg ?
•Localize CULPRIT CORONARY VESSEL
To assess the size of ischemic area
To be prepared for EXPECTED COMPLICATIONS
•PROGNOSIS – ST segment score(> 15 )
•Grading of ischaemia
I – tall peaked symmetric R waves
ii – ST elevation
iii – distortion of terminal QRS

7. CORONARY VASCULAR ANATOMY

8. Sites of occlusion
Proximal l a d
Septal
Diagonal
Distal l a d

9. ECG CHANGES
LOOK AT
PROXIMAL
L A D
MID
L A D
DISTAL
L A D
V 1-4 ST ST ST
II , III , AVFST ST
(III esp.)
ST isoelectric
or
AVR ,

ST ST ST
V 5 , 6 ST
AVL ST
CONDUCTION
DEFECTS
RBBB
LAFB

10. PROXIMAL L A D OCCLUSION

11. PROXIMAL L A D
ST ELEVATION AVR
ST DEPRESSION IN
INFERIOR LEADS ,
V5,6

12. DISTAL L A D OCCLUSION

13. DISTAL L A D
ST DEPRESSION AVR
ST ISOELECTRIC OR
ELEVATED IN INFERIOR
LEADS

14. PROXIMAL TO SEPTAL BR.

15. PROXIMAL TO SEPTAL BR.
ST ELEVATED IN
INFERIOR LEADS (ESP III)
& AVR
ST DEPRESSED IN AVL

16. COMPLICATIONS
Involvement of the distal AV conduction
right bundle branch block (RBBB)
Left fascicular block,
 Heart failure and
 Ventricular tachycardia and fibrillation
<subacute phase>

17. To summarize
……..

18. A SIMPLE CARRY HOME MESSAGE
ASMI

ST elevation in V 1-4

reciprocal ST depression in ii ,iii , aVF
Present absent
DISTAL L A D
ST elevation in V1 , a VR
Present absent ST elevation avr > V1

+ RBBB , LAFB
PROXIMAL MID L A D LT MAIN BR.

20. DISTAL TO SEPTAL BR.

21. DISTAL TO SEPTAL