Professional Documents
Culture Documents
Cardiac
Conduction
System
1
3
2
4
4
5
Purkinje
fibers
12-Lead Electrodes
A lead is a tracing of the electrical activity
between 2 electrodes
Leads view the heart from the front of the body
Top, bottom, right, and left side of heart
1st ICS
2nd ICS
3rd ICS
Precordial
leads
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
II
III
aVR
V1
V4
aVL
V2
V5
V3
aVF
V6
I
aVL
V5
V6
II
III
aVF
V1
V2
V4
V3
Myocardial Insult
Ischemia
lack of oxygenation
ST depression or T wave inversion
permanent damage avoidable
Injury
prolonged ischemia
ST elevation
permanent damage avoidable
Infarct
death of myocardial tissue; damage permanent; may have Q
wave
The J Point
segment meet
ST segment elevation - evaluated 0.04 seconds
(one small box) after J point
Coved
shape
usually
indicates
acute injury
Concave
shape is
usually
benign
especially if
patient is
asymptomatic
Significant ST Elevation
ST segment elevation measurement
starts 0.04 seconds after J point
ST elevation
> 1mm (1 small box) in 2 or more contiguous chest
leads (V1-V6)
>1mm (1 small box) in 2 or more anatomically
contiguous leads (ie: II, III, aVF; I, aVL, V5, V6)
Contiguous lead
limb leads that look at the same area of the heart or
are numerically consecutive chest leads (ie: V1 V6)
Contiguous Leads
Lateral wall: I, aVL, V5, V6
Inferior wall: II, III, avF
Septum: V1 and V2
Anterior wall: V3 and V4
Posterior wall: V7-V9 (leads placed
on the patients back 5th intercostal
space creating a 15 lead EKG)
Evolution of AMI
A - pre-infarct (normal)
B - Tall T wave (first few
minutes of infarct)
C - Tall T wave and ST
elevation (injury)
D - Elevated ST (injury),
inverted T wave (ischemia),
Q wave (tissue death)
E - Inverted T wave
(ischemia), Q wave (tissue
death)
F - Q wave (permanent
marking)
ST Segment
Elevation
EKG monitoring
Evaluates electrical activity of the heart
Can indicate myocardial insult and location
ischemia - initial insult; ST depression seen
injury - prolonged myocardial hypoxia or
ischemia; ST elevation seen
infarction - tissue death
dead tissue no longer contracts
amount of dead tissue directly relates to
degree of muscle impairment
may show Q waves
aVR
not evaluated
V1
Septum
V4
Anterior wall
Lead II
Inferior wall
aVL
Lateral wall
V2
Septum
V5
Lateral wall
Lead III
Inferior wall
aVF
Inferior wall
V3
Anterior
V6
Lateral wall
Case #1
Case #1
52 year-old patient complains of
Case #2
Case #2
62 year-old female developed chest & jaw pain
while in the shower
VS: 110/62; P 66; R 20
Is there ST elevation:
Case #3
Case #3
45 year-old patient who complains of chest
heaviness & lightheadedness
VS: 90/56; P 86; R - 22
Is there ST elevation:
Case #4
Case #4
87 year-old female patient complains of
dizziness and being extremely tired
VS: 88/52; P 30; R - 16
Is there ST elevation:
Case #5
Case #5
58 year-old male patient who complains of chest
pain radiating down the left arm after working
out in the gym
VS: 110/72; P 100; R - 18
Is there ST elevation:
Case #6
Case #6
92 year-old patient complaining of pounding in
her chest for one hour
VS: 98/66; P 110; R- 16
Is there ST elevation:
Case #7
Case #7
36 year-old patient who passed out standing in
line at a bank
VS: 128/78; P 80; R - 20
Is there ST elevation: