ECG OF THE WEEKPROF.DR.DHANDAPANI’S UNITBY-DR.ANIRUDH .J.SHETTY

50 yr old patient francis came with the chief c/o -chest pain for 3 days -retrosternal in location -intermittent in nature -had 2 such episodes ,one lasting for half an hr

and the other for an hour -radiating to the arms

Past h/o –pt is a known case of HTN not a known DM/IHD

O/E- Pt. conscious oriented afebrile

PR-80/MIN BP-110/80mmHg

CVS-S1S2 heard no murmurs

RS-NVBS heard

P/A-Soft

CNS- NFND

Summary

Rate -100 / mt;

Sinus rhythm;

P wave- bifid p waves in lead 2 PR-o.12 secs

QRS axis –normal axis;

QRS duration -0.08 secs

ST depression with tall T waves in V2,V3

ST segment elevation in leads 1 , avL

Impression

In the posterior leads ST elevation > 1 mm in V8

& V9 seen

leading on to the diagnosis of “ POSTERIOR WALL MI “

Since leads 1, avL also shows St elevation;

“ High lateral MI”

•Trop T levels : 0.4 U (N - <0.1 U )

PWMI15-20% of total incidence ,often

accompanied by Inferior or lateral wall MI;

Isolated PWMI only 3.3% ;

Necrosis of the dorsal infraatrial portion of the left

ventricle beneath the AV sulcus

Artery involved: commonly LCX less common is RCA

Ecg criteria for PWMI (v 1 to v 3 )

•ST-segment depression (horizontal >> downsloping/upsloping)*

•Prominent R wave*

•R/S wave ratio >1.0 in lead V2

•Prominent, upright T wave*

•Combination of horizontal ST-segment depression with upright T wave*

•Co-existing acute inferior and/or lateral MI

•- Additional lead ECG (posterior leads V7 to V9)

≥ 1 mm ST-segment elevation

DIFF.DIAG. OF TALL R WAVE IN RT.PRECORDIAL LEADS

• Diagnosis • True posterior infarct

----------

• Right ventricular hypertrophy-

• Rt.bundle branch block--------

• Wolff-parkinson white syndr.----

• Confirmatory clues • ST↓, T↑ in V1-V2; Q waves

and ST↑ V7 to V9

• RAD, RAE; secondary ST-Ts; V7 to V9 normal

• Wide QRS; broad S in V1, V6; R peaks late in V1; V7 to V9 normal or broad S waves

• Short PR; delta wave; V7 to V9 normal or delta wave

COMPLICATIONS Ventricular aneurysm ,rupture with sudden

death is more common with posterior wall

myocardial infarction

Rupture of chordae tendinae leads to mitral valve

Incompetence

Rupture of septum carries a special danger with

increased mortality

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