Presentasi Gelombang Kritis Killer ECG .pptx

EKG

1. Killer ECG

2. Background Unspecific symptoms/ signs  ECG often missed perform Weakness Dizziness Syncope Coexist with other illness/ disease

3. Background ECG overlooked delaying further assessment and treatment

4. Normal ECG

5. Normal ECG

6. PART 1 Coronary Occlusion

7. PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias STEMI We are all familiar with the conventional “STEMI” ECG pattern Even under time pressure and distraction will likely recognise STEMI The other more subtle patterns not meeting traditional STEMI criteria that are easier to miss on quick glance

8. Classic STEMI PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

9. STEMI PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

10. ST evolution PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

11. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Wellen’s Syndrome

12. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Wellen’s Syndrome

13. PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias C ritical LAD stenosis  extremely high risk for extensive anterior MI within the subsequent days to weeks B y the time the ECG is taken: may be pain free normal or minimally elevated cardiac enzymes. Wellen’s Syndrome

14. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias De Winter’s T Wave

15. PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Upsloping ST depression in the precordial leads (> 1mm at J point) Peaked anterior T waves (V2-6), with the ascending limb of the T wave commencing below the isoelectric baseline Subtle ST elevation in aVR > 0.5mm STEMI equivalent De Winter’s T Wave

16. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias LBBB

17. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias LBBB

18. LBBB – Sgarbossa criteria Smith SW et al.  Diagnosis of ST Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule . Annals of Emergency Medicine 2012;60:766-776 PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

19. PART 2 Non Coronary Related

20. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Pre-excitation/ Accessory pathway

21. Pre-excitation/ Accessory pathway PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

22. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Massive Pericardial Effusion

23. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Hyperkalemia

24. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Hyperkalemia

25. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Hyperkalemia

26. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Hypokalemia

27. PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias

28. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Brugada

29. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Brugada

30. PART 3 Malignant Arrhythmias

31. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias R on T PVC/ VES

32. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Salvo

33. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Ventricular Tachycardia

34. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Ventricular Tachycardia

35. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Ventricular Tachycardia

36. ? PART 1 Coronary Occlusion PART 2 Non Coronary Related PART 3 Malignant Arrhythmias Ventricular Fibrillation

37. TAKE HOME MESSAGE ECG interpretation is essentially pattern recognition Subtle presentations of “killer ECG” can be easily missed Practice by looking at as many ECGs as you can If in doubt or under pressure, consult early Recognize early  prevent cardiac arrest THANK YOU