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Myocardial Ishcemia and Infarction

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Myocardial Ishcemia and Infarction

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    1. Myocardial Ishcemia and Infarction Chapter 8: St Segment Elevation Ischemia and Q Wave Infarct Patterns

    2. Terminology Ischemia Angina Pectoris Necrosis Myocardial Infarction Epicardium Subendocardium TransmuraL three major coronary arteries

    3. Transmural Ischemia Acute Phase St segment elevation Sometimes tall T waves in certain leads Acute phase may last hours to days

    4. Transmural Ischemia Evolving phase T wave inversion in the leads where the previously showed ST segment elevation

    5. Transmural Ischemia Location Anterior Leads V1 - V6, I and aVl Inferior Leads II, III and aVf

    6. Anterior MI

    7. Inferior MI

    8. Recipocity

    10. ST Elevation The ST elevation seen with acute MI is called a Current of injury ST segment elevations are the earliest ECG signs of acute MI

    11. Q Waves Q waves are characteristic markers of infarction. (But not all transmural infarcts lead to Q waves.) New Q waves of an MI generally appear with the first day or two With an Anterior MI, these Q waves are seen in one of more of leads V1-V6, I and aVl With an Inferior MI, these Q waves are seen in one of more of leads II, III and aVf

    12. Normal Q Waves

    14. Normal and Abnormal Q Waves Normal Narrow (less than 0.04 sec), Low amplitude Abnormal if greater than 0.04 sec in leads I, II, III, aVf or leads V3 - V6. Wider Q waves in V1, V2, III, and aVf can be normal Not all Q waves are abnormal, Not all Q waves are the result of MI.

    15. Anterior Infarctions Anterior MI show loss of R wave progression in the chest leads Anterospetal Infarcts: Loss of R waves in V1 and V2 Strictly Anterior Infarcts: Loss of R waves in V3 and V4 Anterolateral or Anteroapical infarcts: abnormal Q waves in V5 and V6

    21. Inferior Infarctions Abnormal Q waves in leads II, III, and aVF

    23. Other Posterior Infarctions Right Ventricular Infarctions Ventricular Aneurysm Multiple Infarctions Silent MI MI with Bundle Branch Block

    24. Myocardial Ischemia and Infarction Chapter 9: St Segment Depression Ischemia and non-Q Wave Infarct Patterns

    25. Subendocardial Ischemia Inner layer St Segment depression Anterior leads (I, aVl and V1-V6) Inferior leads (II, III, and aVf) May see ST segment elevation in aVr

    26. Subendocardial Ischemia

    27. Subendocardial Ischemia Transient ST segment depression ST segment depression often occurs with angina, which generally returns to baseline when the angina subsides

    28. Subendocardial Ischemia Exercise

    29. Subendocardial Ischemia ST segment depression criteria 1 mm or more horizontal or downward lasts 0.08 seconds depression of only the J point with rapid upward sloping are considered normal.

    30. Subendocardial Ischemia False-Positive ST depression without disease False-Negative Disease without ST depression Silent Myocardial ischemia

    31. Subendocardial Infarction Persistent ST depression

    32. Subendo-cardial Infarction

    33. Non-Specific ST-T changes Subtle changes slight flattening of T wave minimal T wave inversion

    34. Prinzmetals Angina Transient ST segment elevation with angina No Q waves, no T wave inversion Angina may occur at rest or at night Coronary artery spasm

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