ECG Guru - Instructor Resources - Coronary artery disease https://www.ecgguru.com/ecg/coronary-artery-disease-0 en Subtle ST Elevation And Left Anterior Hemiblock https://www.ecgguru.com/ecg/subtle-st-elevation-and-left-anterior-hemiblock <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/subtle-st-elevation-and-left-anterior-hemiblock"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD%20108%20Crew%20CAlert%20Downgr%20by%20ED.jpg" width="1800" height="559" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">We have no clinical information about this patient, except that he was complaining of chest pain, and was initially treated by prehospital paramedics.</p><p class="MsoNormal"><strong>ST Changes &nbsp; &nbsp; &nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">The paramedics noted a slight J point elevation in the precordial leads, specifically about one mm of elevation in Leads V2, V3, and V4.&nbsp; In addition, the ST segments are curved downward like a frown in V1 and straight in the remaining precordial leads. Because of the patient’s symptoms, and the ST abnormalities, they notified the hospital that they believed this was a STEMI.&nbsp; The patient was transported without complications, and the Emergency Department physician subsequently downgraded the initial assessment of STEMI Alert.&nbsp; We do not have access to follow up.&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">These ST segments are abnormal, but do not necessarily indicate an acute ST-elevation M.I. (STEMI). A flat or “frowning” ST segment DOES suggest coronary artery disease, and the patient’s symptoms are worrisome.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">However, before activating the cath lab emergently, it is sometimes preferable to observe the patient, check cardiac enzymes and other lab results, and repeat ECGs.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">&nbsp;</p><p class="MsoNormal"><strong>Are These ST Changes Due to Acute M.I.?</strong> &nbsp; There are several accepted <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209433/">guidelines</a> in use for evaluating ST segments for STEMI.&nbsp; Some are simplified for ease of use, and some are very detailed, taking into consideration the patient’s age and gender. There are ECG features that INCREASE the chances of ST elevation being due to acute M.I. &nbsp;These features include:</p><p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->ST elevations are in related leads</p><p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;"><span style="text-indent: -0.25in; font-size: 13.008px; line-height: 1.538em; font-family: Symbol;">·<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><span style="text-indent: -0.25in; font-size: 13.008px; line-height: 1.538em;">ST segments are flat or convex upward (frowning)</span><span style="text-indent: -0.25in; font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->There are reciprocal ST depressions</p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->There are associated ECG signs of M.I. such as pathological Q waves and inverted T waves</p><p class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><!--[endif]-->J points are higher than 1 mm (females have less STE requirement for M.I. diagnosis)&nbsp;&nbsp; Leads V2 and V3 generally require 2 mm of STE for a STEMI diagnosis.</p><p class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo1;">As we evaluate this ECG, we see that the subtle ST elevations are in related leads (V1 - V3). &nbsp;They are flat (V2 and V3) &nbsp;or convex (V1). &nbsp;There is NO reciprocal depression of the ST segments. &nbsp;There are NO pathological Q waves. T waves are inverted in V1 and flat in Lead III, a non-specific finding. &nbsp;And the J points are minimally elevated at 1 mm or less. By most standard protocols, this ECG does not meet the criteria for acute STEMI. &nbsp;This does NOT rule out the possibility of M.I.</p><p class="MsoNormal"><strong>Other Considerations</strong> &nbsp; &nbsp;It is worth noting that strictly “normal” R wave progression is not seen in this ECG.&nbsp; Leads V2 through V6 show normal R wave progression.&nbsp; That is, the R waves progressively become proportionately larger, while the S waves regress.&nbsp; V1, however, does not have the morphology expected, a small r wave and a deep S wave. We are not sure if this is a lead placement issue or not.&nbsp; When V1 has abnormalities not shared by V2, we sometimes see similar changes in Lead III, because V1 and Lead III are both oriented toward the heart’s right side.&nbsp; In this ECG, Lead III does not resemble Lead V1.&nbsp; Also, there is a left axis deviation.&nbsp; If no other cause for left axis deviation is readily apparent, the cause is presumed to be <span style="color: #0070c0;"><a href="http://lifeinthefastlane.com/ecg-library/basics/left-anterior-fascicular-block/">LEFT ANTERIOR HEMIBLOCK</a></span>, also called left anterior fascicular block.&nbsp; LAH is sometimes caused by anterior-septal M.I., with an incidence of about 7-15%.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Ref.:<a href="http://journal.publications.chestnet.org/solr/searchresults.aspx?q=Marriott&amp;allJournals=1&amp;restypeid=3"> <span style="font-size: 9.5pt; line-height: 107%; font-family: inherit, serif; border: 1pt none windowtext; padding: 0in;">Marriott HJL, Hogan RN. Hemiblock in acute myocardial infarction.&nbsp;<em>Chest.</em>1970;&nbsp;58:&nbsp;342–344.</span></a></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/226/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Subtle ST Elevation And Left Anterior Hemiblock 1/5</option><option value="40">Give Subtle ST Elevation And Left Anterior Hemiblock 2/5</option><option value="60">Give Subtle ST Elevation And Left Anterior Hemiblock 3/5</option><option value="80">Give Subtle ST Elevation And Left Anterior Hemiblock 4/5</option><option value="100" selected="selected">Give Subtle ST Elevation And Left Anterior Hemiblock 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.3</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-NCE_Z88nTzXAo1DWIC1B6TbO1_cY_wTIM_aMX750x_U" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/left-anterior-hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left anterior hemiblock</a></div><div class="field-item odd"><a href="/ecg/left-anterior-fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left anterior fascicular block</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsubtle-st-elevation-and-left-anterior-hemiblock&amp;title=Subtle%20ST%20Elevation%20And%20Left%20Anterior%20Hemiblock"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Mon, 01 Feb 2016 05:11:50 +0000 Dawn 685 at https://www.ecgguru.com https://www.ecgguru.com/ecg/subtle-st-elevation-and-left-anterior-hemiblock#comments Deep, Symmetrical T Wave Inversions https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/deep-symmetrical-t-wave-inversions"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/T%20wave%20inversions.jpg" width="1800" height="614" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a 50-year-old man with chest pain.&nbsp; Unfortunately, we don’t have any other clinical information.&nbsp;&nbsp; This tracing is a good example of widespread, symmetrical inverted T waves.&nbsp; Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads).&nbsp; There are ST segment elevations in Leads V1 and V2.&nbsp;<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Many conditions can cause inverted T waves, and bedside assessment is necessary to make a certain diagnosis.&nbsp; Some T wave inversions are benign, such as in persistent juvenile T wave pattern.&nbsp; Some can be due to life-threatening problems like pulmonary embolism, CNS injury, and cardiac ischemia.&nbsp; T wave inversions can be secondary to conditions like left ventricular hypertrophy, left bundle branch block, and ventricular rhythms.&nbsp; When T waves are deep and symmetrical as they are here, they may be a sign of acute coronary syndrome, or cardiac ischemia.&nbsp; Since we know this patient had chest pain, and there is some ST elevation, this should be considered as a cause for his T wave changes.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">In addition to the dramatic T waves, he also has P waves suggestive of “P mitrale”, or left atrial enlargement.&nbsp; The P waves in Lead II are wide (about 10 or 11 ms) and just over 1 mv tall. This is “borderline” for most <a href="http://lifeinthefastlane.com/ecg-library/basics/left-atrial-enlargement/">LAE criteria</a>. &nbsp;&nbsp;The P waves in Lead V1 are biphasic, with the second portion negatively deflected and over 1 mv deep.&nbsp; Acute myocardial infarction can cause left ventricular dysfunction, which can cause backup pressure to the left atrium.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Inverted T waves, like all ST and T wave changes, should always be assessed in the context of the patient presentation, history, and previous ECGs, if available.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p><span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">References:&nbsp; <a href="http://www.consultantlive.com/cardiovascular-diseases/inverted-t-wave-differential-diagnosis-adult-patient">Consultantlive.com, </a>&nbsp;&nbsp;<a href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html">Dr. Ken Grauer</a> </span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/226/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Deep, Symmetrical T Wave Inversions 1/5</option><option value="40">Give Deep, Symmetrical T Wave Inversions 2/5</option><option value="60">Give Deep, Symmetrical T Wave Inversions 3/5</option><option value="80" selected="selected">Give Deep, Symmetrical T Wave Inversions 4/5</option><option value="100">Give Deep, Symmetrical T Wave Inversions 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-mbysmVJEmmKMqUtUNN0v8514U5w3jbGZJuTgTcnTQMM" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/coronary-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary syndrome</a></div><div class="field-item odd"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fdeep-symmetrical-t-wave-inversions&amp;title=Deep%2C%20Symmetrical%20T%20Wave%20Inversions"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 16 Dec 2015 03:20:58 +0000 Dawn 680 at https://www.ecgguru.com https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions#comments Inferior Wall M.I. Due To Circumflex Artery Occlusion https://www.ecgguru.com/ecg/inferior-wall-mi-due-circumflex-artery-occlusion <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-due-circumflex-artery-occlusion"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IW116%20WEIM%20-%20have%20cath.jpg" width="1800" height="1368" alt="" /></a></div><div class="field-item odd"><a href="/ecg/inferior-wall-mi-due-circumflex-artery-occlusion"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/weim%20lca%20dis%2023_frame_0036.jpg" width="506" height="457" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG is from an 81 year old woman with an extensive history of coronary artery disease. &nbsp;She was experiencing chest pain at the time of the ECG. &nbsp;We can clearly see ST elevation in Leads II, III, and aVF, indicating an inferior wall ST-elevation M.I. (STEMI). &nbsp;There are reciprocal ST depressions in Leads I and aVL. &nbsp;There are subtle and less specific ST changes in V1 (flat ST and T), V2 (ST depression), V3 (ST elevation and inverted T wave), and V4 through V6 (slight ST elevation). &nbsp;The flat, horizontal shape of most of the ST segments is another clue to her CAD. &nbsp;What coronary artery do you think is the culprit for the ST elevation?</p><p>This patient received coronary angiography, so we do not have to guess at where her lesions are. &nbsp;She was found to have an occluded left internal mammary artery (LIMA) graft.</p><p>The left anterior descending coronary artery (top of view) is very diseased, with some extremely narrow areas. &nbsp;The circumflex artery is large and covers a lot of area, but it, too, is very diseased, with a critical occlusion (marked with arrow). &nbsp;On this day, the circumflex artery received angioplasty and stents. &nbsp;The patient's right coronary artery was patent.</p><p>In approximately 85% of the population, the RCA supplies the inferior wall of the heart. &nbsp;In most of the rest, a branch of the circumflex supplies the posterior/inferior wall.</p><p>This patient also has a very interesting arrhythmia. &nbsp;We see P waves (numbered) that appear regular for three beats, then we see no P waves for a pause. &nbsp;Then, three more P waves appear. &nbsp;There is no readily-seen "hidden" P wave in the ST segments or T waves. &nbsp;Even though there appear to be "progressively prolonging PR intervals", the PR intervals of each group of three do not match the other group of three. &nbsp;The first "PRI" - P wave number 1- and the last one - P wave number 7 - appear too short to be normal PR intervals. &nbsp;The ventricular rate is regular, and the QRS complexes are slightly wide at &nbsp;.10 sec. &nbsp;The rate is 54 bpm. &nbsp;This suggests junctional rhythm.</p><p>We are eager to hear your comments regarding this rhythm.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/226/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Inferior Wall M.I. Due To Circumflex Artery Occlusion 1/5</option><option value="40">Give Inferior Wall M.I. Due To Circumflex Artery Occlusion 2/5</option><option value="60">Give Inferior Wall M.I. Due To Circumflex Artery Occlusion 3/5</option><option value="80" selected="selected">Give Inferior Wall M.I. Due To Circumflex Artery Occlusion 4/5</option><option value="100">Give Inferior Wall M.I. Due To Circumflex Artery Occlusion 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.9</span></span> <span class="total-votes">(<span >7</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-m4S6W2pN0IOkXxrGDnAP0tTJAtDeOLC9mtkfgfKuoRI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior Wall M.I.</a></div><div class="field-item odd"><a href="/ecg/circumflex-artery" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Circumflex artery</a></div><div class="field-item even"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finferior-wall-mi-due-circumflex-artery-occlusion&amp;title=Inferior%20Wall%20M.I.%20Due%20To%20Circumflex%20Artery%20Occlusion"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 26 Oct 2013 03:26:34 +0000 Dawn 507 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inferior-wall-mi-due-circumflex-artery-occlusion#comments Anterior Wall M.I. https://www.ecgguru.com/ecg/anterior-wall-mi-1 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW101A%2B.jpg" width="1800" height="1397" alt="" /></a></div><div class="field-item odd"><a href="/ecg/anterior-wall-mi-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW101B%2B_0.jpg" width="1800" height="1326" alt="" /></a></div><div class="field-item even"><a href="/ecg/anterior-wall-mi-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW101C%2B.jpg" width="1800" height="1351" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This series of three ECGs is from a 75-year-old woman who came to the Emergency Dept. with chest pain. &nbsp;The <strong>first ECG</strong> shows ST elevation in V1, V2, and V3, with generally low voltage in the QRS complexes. There is some coving upward of the ST segment in aVR, which can suggest a very proximal lesion of the left coronary artery (LCA). &nbsp;She was taken to the cath lab, where it was discovered that she had a 100% occlusion of the midportion of the anterior descending branch of the left coronary artery, which was repaired and stented. &nbsp;The <strong>second ECG,&nbsp;</strong>taken after the angioplasty, shows some Q waves in V1 and V2, with poor R wave progression in the V leads. &nbsp; A 25% occlusion of the obtuse marginal branch of the circumflex artery was stented two days later. The<strong> third ECG</strong> was obtained after that procedure. &nbsp;It shows that the Q waves have disappeared in the anterior leads (possibly due to different technicians performing the ECGs with different lead placement). &nbsp;It also shows marked T wave inversion in I and aVL, representing ischemia in the lateral wall, and in all the chest leads, representing ischemia in the anterior wall. &nbsp;The QTc is prolonged in this third ECG at 479 ms. &nbsp;It is not known what medications the patient was on. &nbsp;This patient also had a 50% proximal occlusion in the RCA and a 75% occlusion in the posterior descending artery. &nbsp; This is a good example of a patient with extensive coronary artery disease who finally presented for treatment when she developed ST elevation M.I. &nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/226/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Anterior Wall M.I. 1/5</option><option value="40">Give Anterior Wall M.I. 2/5</option><option value="60">Give Anterior Wall M.I. 3/5</option><option value="80" selected="selected">Give Anterior Wall M.I. 4/5</option><option value="100">Give Anterior Wall M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.3</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-cx2iq-F1HrHPffdkxg6ppEn4-e3qDccgO5cHsh4_u5Y" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-5" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior wall M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/cad" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">CAD</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanterior-wall-mi-1&amp;title=Anterior%20Wall%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 27 Aug 2013 21:03:26 +0000 Dawn 488 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anterior-wall-mi-1#comments Coronary Artery Disease https://www.ecgguru.com/ecg/coronary-artery-disease <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/coronary-artery-disease"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD100.jpg" width="1400" height="1037" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG was taken from a 49 year old man with insulin-dependent diabetes, with no complaints of cardiac symptoms.&nbsp;&nbsp;The rest of this patient's history is lost.&nbsp; &nbsp;This is a great ECG for demonstrating the flat ST segments and T wave inversion of ischemia due to coronary artery disease. The ECG changes are&nbsp;very noticeable in the lateral wall.&nbsp; It is not known why the patient presented with sinus tachycardia.<br /><br />&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/226/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Coronary Artery Disease 1/5</option><option value="40">Give Coronary Artery Disease 2/5</option><option value="60">Give Coronary Artery Disease 3/5</option><option value="80">Give Coronary Artery Disease 4/5</option><option value="100">Give Coronary Artery Disease 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-hEOXaBtzqHgaQiwDDiud2Ri29dpVhvKWeO6Fd-fh-84" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fcoronary-artery-disease&amp;title=Coronary%20Artery%20Disease"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 31 Oct 2011 19:11:40 +0000 Dawn 47 at https://www.ecgguru.com https://www.ecgguru.com/ecg/coronary-artery-disease#comments