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Comprehensive 6-Step Approach to Ischaemia Diagnosis in Clinical Practice

This guide outlines a systematic 6-step approach to diagnosing ischaemia, focusing on key ECG elements like rate, rhythm, P waves, QRS complex, ST segment, T waves, and axis deviations. It details major and minor criteria for identifying ischaemic abnormalities through clinical scenarios, such as patients with chest pain and other presenting symptoms. Learn to interpret ECGs effectively, considering contiguous leads and horizontal/vertical axes. Ideal for healthcare professionals seeking a structured method to improve diagnostic accuracy.

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Comprehensive 6-Step Approach to Ischaemia Diagnosis in Clinical Practice

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  1. Ischaemia 6 Step Approach Raj Chahal April 2012

  2. 6 STEP APPROACH • RATE AND RHYTHM • P WAVES • QRS • ST SEGMENT • T WAVES • AXIS

  3. CONTEXT!! • Symptoms • Age & Risk Factors • Story • 70 year old male smoker with 1 hours of central chest ache • 23 year old pregnant lady with calf pains, then sharp pleuritic chest pains • 75 year old lady with dysuria, history of MI 2 years ago, no recent pains

  4. Major Criteria • ST SEGMENT ELEVATION • ST SEGMENT DEPRESSION • T WAVE INVERSION • NEW LEFT BUNDLE BRANCH BLOCK

  5. Minor Criteria • T WAVE FLATTENING • BIPHASIC T WAVES • Q WAVES • PROLONGED QTc INTERVAL

  6. REMEMBER CONTIGUOUS LEADS • THROUGH HORIZONTAL AND VERTICAL AXIS • V1 – V2 – V3 – V4 – V5 – V6 • AVL – I – II – AVF – III – AVR

  7. Axis

  8. EXAMPLES • RATE AND RHYTHM • P WAVES • QRS • ST SEGMENT • T WAVES • AXIS

  9. ECGs IN PRACTICE Have a look at the following ECGs in small groups and decide what the ischaemic abnormality is…?

  10. Any Questions…?

  11. Thank you ECGs courtesy of – ECGs By Example 2nd Ed, Jenkins & Gerred, Elsevier 2005.

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