Atrial abnormality https://www.ecgguru.com/taxonomy/term/484/all en Anterior Wall M.I. https://www.ecgguru.com/ecg/anterior-wall-mi-2 <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-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW119B%20Hosp%20ECG.jpg" width="1800" height="1312" 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>A 78-year-old woman complained of nausea and diaphoresis. &nbsp;Paramedics in the field found that her 12-lead ECG showed ST elevation in V1 through V4, aVL, and aVR. &nbsp;The patient denied chest pain and also denied any cardiac history. &nbsp;She did not want to be transported to the hospital, but thankfully, the paramedics understood that this was not an option, and convinced her to go.</p> <p>She was taken to a cardiac facility as a STEMI Alert, was evaluated in the cath lab, and sent immediately to the O.R. for coronary artery bypass surgery. &nbsp;She had severe multi-vessle disease and a lesion in her proximal left coronary artery. &nbsp;No other details of the cath results are known.</p> <p>Some important teaching points:</p> <ul> <li>there is subtle ST elevation in V1 and V2, but the SHAPE of the ST segment is suspect, with flattening and almost a coving upward shape in V1. &nbsp;Normal ST segments are convex downward, like a smile.</li> <li>there is nearly complete loss of r waves in V1 and V2, and V3 and V4 have very small r waves. &nbsp;This signals impending pathological Q waves, a sign of necrosis of the myocardium. &nbsp;Necrotic muscle does not contract.</li> <li>there is slight ST segment elevation in aVR. &nbsp;Along with STE in V1, this is a marker for proximal LCA or left main occlusion.</li> <li>the ST elevations in V3 and V4 are more pronounced, and easily meet STEMI guidelines: &nbsp;currently 1.5 mm of elevation in V3 and 1 mm of elevation in V4 for a woman.</li> <li>there are reciprocal ST depressions in II, III, and aVF - common in AWMI.</li> <li>aVL has slight STE, along with inverted T waves. Somewhat surprisingly, there is no ST depression in Lead I. &nbsp;This indicates high lateral wall injury.</li> <li>the patient has a "hint" of the criteria for LVH: &nbsp;her S wave in V3 + her R wave in V5 = about 33 mm, and there is depression in V6. &nbsp;A stretch to call it "LVH", but possibly a sign of left ventricular strain because of the acute M.I.</li> <li>there are atrial abnormalities suggested by the tall, peaked P waves in Lead II, the "M" shaped P waves in Lead III, and the inverted P waves in V1 and V2. &nbsp;Possibly bi-atrial dilation and stress brought on by the M.I.? &nbsp;An echocardiogram would be a better test for this.</li> <li>the heart rate, at about 90 bpm, reflects NSR but is a cause of more stress on an overworked, injured heart.</li> </ul> <p>This is a great teaching ECG, and we hope the Gurus out there will add even more interesting points to consider.</p> </div></div></div> Thu, 06 Mar 2014 03:27:18 +0000 Dawn 559 at https://www.ecgguru.com