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.
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 ECG and rhythm strip are from a 78 year old man with chest pain, but we have no other clinical data. This is a good example of inferior and low lateral injury, demonstrating the large amount of heart muscle that can be damaged when a dominant RCA or circumflex artery is occluded. The low lateral wall is often included in an inferior wall M.I. when the RCA wraps around the left side of the heart, or the circumflex perfuses the posterior descendng artery and the inferior wall.
This ECG was obtained from a woman with chest pain who was taken to the cath lab and found to have a 100% occlusion of her circumflex artery.
This ECG was taken from a 60 year old man who was complaining of severe substernal chest pain, radiating to his left arm and a non-productive cough. There was some initial discussion among the EMS crew about the possibility of the ECG showing a "benign early repolarization" pattern because of the concave upward ("smiling") ST segments.
A series of ECGs can be a valuable addition to any teacher's collection. This series follows a 75-year-old woman through three days, during which she experienced an acute anterior wall M.I., a catheterization with angioplasty and stents placement.
This ECG depicts an extensive and ultimately, fatal, injury. There is marked ST segment elevation in Leads V2 through V6 (anterior wall). There is also ST elevation in Leads I and aVL (high lateral wall). The ST elevation in aVR is indicative of a very proximal lesion in the left coronary artery, which supplies the anterior wall, including the anterior portion of the septum, the high lateral wall, and, in this case, the low lateral wall. The inferior leads, II, III, and aVF, show reciprocal ST depression.
This series of ECGs was taken during ambulance transport of a 67 year old man with chest pain. Earlier the same week, this man had been discharged from the hospital after having a cardiac cath, angioplasty, and stents. He was discharged the next day. The patient stated that, until that hospital admission, he was healthy, athletic, and had no significant medical history. He is currently taking a statin, atenolol, and "one of the new blood thinners" - he didn't know the name.
This week's ECG for your collection was kindly donated by Dr. Stasinos Theodorou, interventional cardiologist with the Limassol Cardiology Practice in Cyprus. It offers a wonderful teaching opportunity, and illustrates how valuable an ECG can be in locating a lesion during an M.I. Dr.
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