SUBTLE ST CHANGES This ECG was obtained from an 87-year-old man who was experiencing chest pain. Due to the subtle ST elevation in Leads II, III, aVF, V5, and V6, (inferior- lateral walls) the ECG was transmitted to the hospital by the EMS crew, and the cath lab was activated. The patient denied previous cardiac history.
Inferior Wall M.I.
This ECG is a good example of an inferior wall M.I. that was confirmed and treated in the cath lab.
The ST segments are elevated in Leads II, III, and aVF, but the amount of elevation may look subtle to some. When the amount of elevation seems small, what other signs can help us recognize acute ST-elevation M.I.?
This ECG shows a common manifestation with inferior wall M.I., BRADYCARDIA. We see the signs of acute inferior wall M.I.
This ECG was obtained from a patient who suffered an obstruction of the circumflex coronary artery. Unfortunately, he was in the approximately 15-18% of the population in whom the circumflex artery is dominant. That means that it connects with the posterior descending artery, perfusing not only the lateral wall of the left ventricle, but also the posterior and inferior walls. In this case, the obstruction is in the midportion of the artery, and the high lateral wall is spared.
This ECG is from an 80-year-old woman who had an acute inferior wall M.I. with a second-degree AV block.
Some people incorrectly call ALL second-degree AV blocks that are conducting 2:1 "Type II". This is incorrect, as Mobitz Type I can also conduct with a 2:1 ratio. The progressive prolongation of the PR interval will not be seen with a 2:1 conduction ratio, because there are not two PR intervals in a row.
This 31-year-old man presented to the Emergency Dept. complaining of chest pain, shortness of breath, and nausea. His heart rate on admission was 120 - 130 bpm and irregular, and the monitor showed atrial fibrillation. His rate slowed with the administration of diltiazem. His 12-lead ECG shows the classic ST elevation of inferior wall M.I. in Leads II, III, and aVF.
This is from a Cardiac Alert patient, with chest pain, in the Emergency Department. The ECG shows ST elevation in the inferior leads (II, III, and aVF), and in the low lateral leads (V5 and V6). There is reciprocal depression in V1 and V2, indicating injury in the posterior wall. One could argue that "inferior" is just the term we use for the lower part of the posterior wall - the part that faces the floor in a standing person.
This ECG shows two obvious abnormalities, right bundle branch block AND inferior wall M.I. It is also a good teaching example of how the terminal wave of RBBB can be mistaken for the ST elevation of M.I.
First, check this ECG to see if it meets the criteria for right bundle branch block:
1) The QRS will be wide. That is, it will be greater than or equal to .12 seconds (120 ms). In this case, the QRS is 134 ms.
This ECG is taken from a 66-year-old man who presented to the Emergency Dept. with a complaint of chest pain. The ECG shows clear signs of acute inferior wall MI: ST segment elevation in Leads II, III, and aVF and reciprocal ST depression in Leads I and aVL. In addition, there are reciprocal ST depressions in Leads V1, V2, and V3. These indicate that the MI extends up the inferior wall into the area called by most clinicians the posterior wall.
This 88-year-old woman was brought to the Emergency Department in cardiogenic shock. Very little is known of her past medical history, but it was relayed to the EMS responders that she had been ill for about four days, when she became much worse.
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