22 practice 3
TRANSCRIPT
12-Lead ElectrocardiographySTEMI vs. STE-Mimic
Adam Thompson, EMT-P, A.S.
Practice
3
73 y/o Male
Diaphoresis
73 y/o Male
Rate & Rhythm
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
ERAD LAD
RAD Normal
180 0
-90
90
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
- I I +
aVF +
aVF -
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
- I I +
aVF +
aVF -
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
- I I +
aVF +
aVF -
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVB
ERAD LAD
RAD Normal
180 0
-90
90
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVBRight Axis Deviation
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
73 y/o Male
Axis
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
Frontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
73 y/o Male
Intervals & Morphology
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
73 y/o Male
Intervals & Morphology
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
73 y/o Male
Intervals & Morphology
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
73 y/o Male
Intervals & Morphology
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
73 y/o Male
Intervals & Morphology
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave Progression
Frontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
73 y/o Male
STE-Mimics
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
STE-Mimics
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
STE-Mimics
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
Ischemia, Injury, Infarct
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
Ischemia, Injury, Infarct
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBB
73 y/o Male
Ischemia, Injury, Infarct
Rate: 71Normal Sinus - 1st AVBRight Axis DeviationEarly R-Wave ProgressionRBBBAntero-Septal Infarct
B
Practice
• More practice in the next lesson…