12 lead

V1 and V2

septal infarct

V3 and V4

anterior infarct

V5-V6

lateral infarct

avL and I

lateral infarct

II, III, aVF

inferior

posterior looks like?

recipricol changes on V1-V4

describe what the different 12 lead things mean

peaked T waves- ischemia (0 min)

ST elevation- injury (20-40 min)

Q wave WITH ST-elevation- infarct started some is still just injured (30 minutes)

Q wave deepens. STE may decrease and T waves may invert- infarct complete with little injury boundry between infarct and healthy cells. (24 hours)

Deep permanent Q wave- infarct complete- permanent (1-3 days)

note- infarcted cells replace with connective tissue which can lead to an aneurysm

criteria for SIGNIF St elevation

j point >1mm above the baseline in 2 adjacent OR anatomically contiguous leads

Criteria for significant pathological Q waves

Q wave >0.04 sec (1 baby box wide) in duration OR >25% the height of the adjacent R wave OR QS complexes (just an upside down triagle)

AND in 2 or more adjacent or anatomically contiguous leads

what are the caveats for signif ST elevation

in V2-V3

Males younger than 40- STE>2.5mm

Males 40+ years of age >2.0mm

females: >1.5 mm

V1-3 or V2-4

Anteroseptal

2 or more inferior leads plus 2 or more lateral

inferolateral

Any 2 leads from a single surface plus a SINGLE LEAD from adjacent surface

example anteroseptal with lateral extension

you add “extension” at the end

V7-V9 2 or more

posterior infarct

posterior 2 or more plus lateral 2 or more

posterolateral

what can you do if you suspect right sided MI

V4R

Reciprocal changes

depression in Inferior leads (usually III)

Anterior infarct or lateral infarct

Reciprocal changes

depression in anterior and lateral leads (aVL)

inferior

Reciprocal changes

depression in V1-3 and Tall R

Posterior

what does the LAD perfuse

anterior 2/3 of the septum, anterior wall LV, bundles branches

what does the RCA perfuse

inferior wall/AV node in 90% of pts, SA node in 50% +, RV

LCx perfuses?

lateral wall, inferior wall/AV node in 10% population

what complications may be seen in septal infarct

BBB (LBBB>RBBB), M2 and 3rd degree with wide QRS

what complications may be seen in anterior infarct

severe LVF with pulmonary edema and cardiogenic shock

what complications may be seen in lateral infarct

moderate LVF, CHF, 10% less mortality than anterior

what complications may be seen in inferior infarct

Av blocks with normal QRS, RHF, with RV infarct, atrial arythmias

when the LAD is occluded what areas are effected

septum and anterior wall

when the lcx is occluded what area is effected

lateral wall and inferiolateral MI (the 10%)

when the Left main coronary artery is occluded, what area is effected

anterior and lateral

Lead 1 positive

AVF negative

what do we check

what does it mean

we check lead 2

if lead 2 is positive, then we have physiologic LAD (L phys)

if its negative then we have pathological LAD (L path)