22 practice 3

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…