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Ischaemia

Ischaemia. 6 Step Approach Raj Chahal April 2012. 6 STEP APPROACH. RATE AND RHYTHM P WAVES QRS ST SEGMENT T WAVES AXIS. CONTEXT!!. Symptoms Age & Risk Factors Story 70 year old male smoker with 1 hours of central chest ache

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Ischaemia

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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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