The document discusses localization of myocardial ischemia, injury, and infarction based on electrocardiogram (ECG) findings. It provides information on interpreting ST segment changes and T-wave abnormalities in different leads to localize occlusion in the left anterior descending, right coronary artery, or left circumflex arteries. Reciprocal changes are also discussed as indicators of occlusion location.
8. Anatomy of Left ventricle Dr. UZMA ANSARI According to new terminology infero posterior should be called infero basal - Source: AHA Oct 15, 2010 Base/posterior surfase
13. Dr. UZMA ANSARI Oct 15, 2010 RCA RA and part of LA, RV, Posterio superior IV septum. SN, AV node Acute Marginal Inferior and diaphragmatic surface of RV Conus Branch Outflow track of RV SN branch RA, LA,SN RV Branch RV Atrial Branch Right Atrium
14. Localization - Left Coronary Artery (LCA) Dr. UZMA ANSARI Oct 15, 2010 January 2004
17. Prevalence of Culprit Artery Dr. UZMA ANSARI 57% Oct 15, 2010 RCA 45% LCX 12% LAD 36%
18. Prevalence of STEMI Dr. UZMA ANSARI Oct 15, 2010 Inferior 58% Anterior 39% Other 3%
19.
20. Localization Dr. UZMA ANSARI I Lateral II Inferior III Inferior aVR aVL Lateral V1 Septal aVF Inferior V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral Oct 15, 2010 January 2004 The changes of ischemia/injury/infarction are seen in the leads Over lying the area involved
21. Localization Dr. UZMA ANSARI Inferior: II, III, AVF Septal: V1, V2 Anterior: V3, V4 Lateral: I, AVL, V5, V6 Oct 15, 2010 January 2004 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6
22. Frontal Plane Leads Dr. UZMA ANSARI aVL -30 0 I II III 0 0 aVF -aVR +90 0 +60 0 +120 0 -150 0 30 0 Oct 15, 2010
23. Recommendations Dr. UZMA ANSARI - AHA guidelines ‘ ECG machines should be equipped with switching systems that will allow the limb leads to be displayed and labelled appropriately in their anatomically contiguous sequence’ Oct 15, 2010 aVL, Lateral II, Inferior V1 septal V4 anterior I,Lateral aVF Inferior V2 septal V5 lateral -aVR III, inferior V3 anterior V6 lateral
24. Localization - Myocardial Infarct Dr. UZMA ANSARI The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG). Oct 15, 2010 Localization ST elevation Reciprocal ST depression Coronary Artery Anterior MI V1-V6 None LAD Septal Mi V1-V4, disappearance of septum Q in leads V5,V6 none LAD Lateral MI I, aVL, V5, V6 II,III, aVF (inferior leads) LCX Inferior MI II, III, aVF I, aVL (lateral lead) RCA (80%) or LCX (20%) Posterior MI V7, V8, V9 high R in V1-V3 with ST depression V1-V3 > 2mm (mirror view) RCA or LCX Right Ventricle MI V1, V4R I, aVL RCA Atrial MI PTa in I,V5,V6 PTa in I,II, or III RCA
25. Anterior Wall Dr. UZMA ANSARI I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Oct 15, 2010