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2 For more presentations ECG Rhythm Interpretation Module V Acute Myocardial Infarction

3 For more presentations Course Objectives To recognize the normal rhythm of the heart - Normal Sinus Rhythm. To recognize the 13 most common heart arrhythmias. To recognize an acute myocardial infarction on a 12-lead ECG.

4 For more presentations Learning Modules ECG Basics How to Analyze a Rhythm Normal Sinus Rhythm Heart Arrhythmias Diagnosing a Myocardial Infarction Advanced 12-Lead Interpretation

5 For more presentations Diagnosing a MI To diagnose a myocardial infarction you need to go beyond looking at a rhythm strip and obtain a 12-Lead ECG. Rhythm Strip 12-Lead ECG

6 For more presentations The 12-Lead ECG The 12-Lead ECG sees the heart from 12 different views. Therefore, the 12-Lead ECG helps you see what is happening in different portions of the heart. The rhythm strip is only 1 of these 12 views.

7 For more presentations The 12-Leads The 12-leads include: –3 Limb leads (I, II, III) –3 Augmented leads (aVR, aVL, aVF) –6 Precordial leads (V 1 - V 6 )

8 For more presentations Views of the Heart Some leads get a good view of the: Anterior portion of the heart Lateral portion of the heart Inferior portion of the heart

9 For more presentations ST Elevation One way to diagnose an acute MI is to look for elevation of the ST segment.

10 For more presentations ST Elevation (cont) Elevation of the ST segment (greater than 1 small box) in 2 leads is consistent with a myocardial infarction.

11 For more presentations Anterior View of the Heart The anterior portion of the heart is best viewed using leads V 1 - V 4.

12 For more presentations Anterior Myocardial Infarction If you see changes in leads V 1 - V 4 that are consistent with a myocardial infarction, you can conclude that it is an anterior wall myocardial infarction.

13 For more presentations Putting it all Together Do you think this person is having a myocardial infarction. If so, where?

14 For more presentations Interpretation Yes, this person is having an acute anterior wall myocardial infarction.

15 For more presentations Other MI Locations Now that you know where to look for an anterior wall myocardial infarction lets look at how you would determine if the MI involves the lateral wall or the inferior wall of the heart.

16 For more presentations Other MI Locations First, take a look again at this picture of the heart. Anterior portion of the heart Lateral portion of the heart Inferior portion of the heart

17 For more presentations Other MI Locations Second, remember that the 12-leads of the ECG look at different portions of the heart. The limb and augmented leads see electrical activity moving inferiorly (II, III and aVF), to the left (I, aVL) and to the right (aVR). Whereas, the precordial leads see electrical activity in the posterior to anterior direction. Limb LeadsAugmented LeadsPrecordial Leads

18 For more presentations Other MI Locations Now, using these 3 diagrams lets figure where to look for a lateral wall and inferior wall MI. Limb LeadsAugmented LeadsPrecordial Leads

19 For more presentations Anterior MI Remember the anterior portion of the heart is best viewed using leads V 1 - V 4. Limb LeadsAugmented LeadsPrecordial Leads

20 For more presentations Lateral MI So what leads do you think the lateral portion of the heart is best viewed? Limb LeadsAugmented LeadsPrecordial Leads Leads I, aVL, and V 5 - V 6

21 For more presentations Inferior MI Now how about the inferior portion of the heart? Limb LeadsAugmented LeadsPrecordial Leads Leads II, III and aVF

22 For more presentations Putting it all Together Now, where do you think this person is having a myocardial infarction?

23 For more presentations Inferior Wall MI This is an inferior MI. Note the ST elevation in leads II, III and aVF.

24 For more presentations Putting it all Together How about now?

25 For more presentations Anterolateral MI This persons MI involves both the anterior wall (V 2 -V 4 ) and the lateral wall (V 5 -V 6, I, and aVL)!

26 For more presentations End of Module V Acute Myocardial Infarction Proceed to Module V Practice Quiz on WebCT

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