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26 Cards in this Set
- Front
- Back
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Coronary Arteries Location
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The coronary arteries are located in the subepicardium, so the inner part of the ventricular wall, the subendocardium, is very vulnerable to ischemia.
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Subendocardial ischemia
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Subendocardial ischemia is a sign of hypoperfusion caused by coronary artery stenosis during times of increased demand like physical or mental stress. The ECG in subendocardial ischemia shows ST depression. An acute myocardial infarction leads to transmural ischemia with ST elevation
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Other causes of ST elevation
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Pericarditis causes epicardial damage and leads to ST elevation originating from the S wave.
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Transmural ischemia
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Transmural ischemia represents acute myocardial infarction and is characterized by monophasic ST elevation.
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Apical Infarct
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1, V2, V3. V4
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Anteroseptal Infarct
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V2, V3
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Anterolateral infarct
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1, L, V5, V6
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Posterolateral infarct
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3, F, V5, V6
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Inferior infarct
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2,3, F
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Right Ventricular Infarct
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3, F, rV4, V2
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Significant coronary stenosis
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> 75% of a coronary artery which can lead to myocardial ischemia resulting in angina, especially during physical activity or in cold weather. Myocardial ischemia can also be asymptomatic or silent.
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Subendocardial ischemia
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typically leads to horizontal or descending ST depression in the reflecting leads. Ascending ST depressions are only pathologic if > 0.1 mV.
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Upward sloping ST depression
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Upward sloping ST depression is a normal finding which may occur with strong physical activity.
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Horizontal and down sloping ST depressions
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Horizontal and down sloping ST depressions are typical for myocardial ischemia.
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Stress test
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An ascending ST depression is a normal finding during vigorous physical activity, such as an exercise stress test. This is an important aspect in the interpretation of exercise stress tests. After the exercise is stopped, the ST depressions resolve within minutes.
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myocardial infarction
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A myocardial infarction is transmural ischemia caused by the occlusion of a coronary artery and followed by typical sequential ECG changes
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myocardial infarction
early stage |
high T waves rarely seen, lasting only for a few minutes.
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myocardial infarction
Stage I |
ST elevation, R preserved. no or small Q wave
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myocardial infarction
Intermediate stage |
ST elevation with T wave inversion loss of R wave, infarct Q present
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myocardial infarction
Stage 2 |
Infarct Q, T wave inversion, ST normalization
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myocardial infarction
Stage 3 |
Persistent Q, Loss of R wave, Normalization of T wave
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Ventricdular aneurysm
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Persistent ST elevations with inverted T waves are an indication of a ventricular aneurysm
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Causes of Q waves
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Infarction
Insignificant Q waves in 1,2,V5,V6 S1Q3 axis floating Q in 3 WPW delta wave AV rhythm neg P wave |
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Differential diagnosis
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Acute pericarditis
Anterior subendocardial myocardial infarction (non-Q-wave infarction, Hypertrophic (obstructive) cardiomyopathy Severe left ventricular hypertrophy |
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Acute anterior myocardial infarction.
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ST elevation in I, aVL and V1-V4 accompanied by ST depression in II, III, aVF and V6 (reciprocal leads). During the cardiac catheterization, an occlusion of the left anterior descending artery was diagnosed.
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Non-Q-wave infarction of the anterior wall.
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T wave inversion over the anterior leads, no ST elevation and normal progression of R wave amplitudes. The patient felt typical angina. The cardiac enzymes were elevated.
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