ST elevation myocardial infarction ECG signs 2

Infarct pattern in Anterior STEMI, Clinical facts and identification on ECG

1. Acute coronary syndrome STEMI (ECG SIGNS) 2

2. 60 year old Woman is brought in to the ER 5 hours after symptom of chest pain ECG acquisition is done within 10 minutes of arrival  Immediate assessment, given aspirin 162mg chewable po  ECG shows a large anterior STEMI Antiplatelet therapies : Clopidogrel 600mg PO

3. Anterior STEMI Clinical facts: Results from occlusion of the left anterior descending artery (LAD). Carries the worst prognosis of all infarcts , due to larger infarct size How to Recognize an Anterior STEMI ST segment elevation with Q wave formation in the precordial leads (V1-6)  Reciprocal ST depression in the inferior leads (mainly III and aVF)

4. Infarct Pattern Septal : V1-V2 Anterior : V2-V5 Anteroseptal : VV1-V4 Anterolateral : V3-V6, +/- I +aVL Extensive anterior/ anterolateral : V1-V6, + aVL

5. On this EKG, there's ST elevation with “tombstone” features in the precordial leads (V1-6) and high lateral leads (I, aVL)  Occlusion is in proximal LAD and indicates large area infarction with a poor LV EF and increased chance of cardiogenic shock and death

6. In this EKG, there’s maximal ST elevation in the anteroseptal leads (V1-4)  Q waves are present in the septal leads (V1-2)  Mild STE in I, aVL and V5, with reciprocal ST depression in lead III  Hyperacute (peaked ) T waves in V2-4. These features indicate a hyperacute anteroseptal STEMI

7. In this ECG, there’s ST elevation in V1-6 plus I and aVL (most marked in V2-4).   Minimal reciprocal ST depression in III and aVF  Q waves in V1-2, reduced R wave height (a Q-wave equivalent) in V3-4  A premature ventricular complex (PVC) with “R on T’ phenomenon at the end of the ECG; this puts the patient at risk for ventricular arrhythmias

8. In this ECG, there’s Hyperacute T-waves in V2-6 (most marked in V2 and V3) with loss of R wave height  The rhythm is sinus with 1st degree AV block  Premature atrial complexes (beat 4 on the rhythm strip)  Multifocal ventricular ectopy (PVCs of two different types) indicating an “irritable” myocardium at risk of ventricular fibrillation

9. Thanks for your attention