Action potential “AP”Electrocardiograph “ECG”

Hamad Emad Dhuhayr

CONTENTS

1.SOEPEL

2.AP

3.ECG

SUBJECT:

Presenting ComplaintAn 81 year-old Saudi male is admitting to hospital with worsening abdominal pain over the last 2-3 days.

There is no chest pain or dsyponea (shortness of breath), however she complains of  nausea and vomiting.

Past Medical HistoryOn examination of the patient's history it appears that he has a history of hypertension, Type 2 Diabetes mellitus (formerly NIDDM), coronary artery disease status post myocardial infarction (CAD S/P MI) 5 years ago and chronic abdominal pain for the last 2 years without a clear reason.

SOEPEL

OBJECTIVE:

taking history, physical examination

VITAL SIGNS:

*Physical Examination38.8 CRR: 16/min78 bpm210/100 mm/Hg

SOEPEL

EVALUATION (DD):

Myocardiac infraction

Appendicitis

Peptic ulcer

PLAN: ECG , ckmp and troponin *i-t* blood test.

ELABORATION: surgical intervention

SOEPEL

LEARNING GOALS:

AP - ECG

SOEPEL

AP

Localization - Myocardial Infarct 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

11

The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG).

Anterior Wall

V3, V4

• Left anterior chest

• Positive electrode on anterior chest

12

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

Apr 12, 2023

Septal Wall V1, V2

◦ Along sternal borders◦ Look through right ventricle & see

septal wall

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

13Apr 12, 2023

Practice

14

Anteroseptal MIST elevations V1, V2, V3, V4

Apr 12, 2023January 2004

15

Lateral Wall I and aVL

◦ View from Left Arm ◦ lateral wall of left ventricle

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

Apr 12, 2023January 2004

Lateral Wall

V5 and V6◦ Left lateral chest◦ lateral wall of left ventricle

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

16Apr 12, 2023

Lateral Wall

• I, aVL, V5, V6

• ST elevation suspect lateral wall injury

17

Lateral Wall

Apr 12, 2023

Lateral MI

18Apr 12, 2023

19

Inferior Wall

II, III, aVF◦ View from Left Leg ◦ inferior wall of left ventricle

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

Apr 12, 2023

Inferior MI

20Apr 12, 2023

Posterior Leads

• Posterior leads V1, V2• Posterior Infarct with ST Depressions and/ tall R wave • RCA and/or LCX Artery

ST elevation in V7,V8,V9.• Understand Reciprocal changes• The posterior aspect of the heart

is viewed as a mirror image and therefore depressions versus elevations indicate MI• Rarely by itself usually in combo.

Dr. UZMA ANSARI 21Apr 12, 2023January 2004

Apr 12, 2023Dr. UZMA ANSARI 22

ECG 1. The ECG above belongs to a patient with stable angina pectoris. The patient complained of effort angina in the last 2 

weeks. Coronary angiography was performed and then the patient was referred to coronary artery bypass graft operation 

because of 3 vessel disease. ST segment flattening is one of the first signs of coronary ischemia and generally preceedes ST 

segment depression.