2013 MI Imitators
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Transcript of 2013 MI Imitators
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12 Lead ECGMI Imitators
Dana Yost, Senior Paramedic
Paramedic TrainingKing County, WA
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MI Imitators LBBB
LVH
Paced
Ventricular Rhythms
Benign Early
Depolarization
Left Ventricular
Aneurysm
Pericarditis
Cardiomyopathy
Acute Myocarditis
WPW
Hyperkalemia
Hypothermia
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Bundle Branch Block
Delayed depolarization
Can be pre-existing condition
Can be caused by MI
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Bundle Branch Block
Can mimic MI
Can hide evidence of MI
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Bundle Branch Block
May Produce
ST elevation
ST depression
Tall T waves
Inverted T waves
May Hide
ST elevation
ST depression
Tall T waves
Inverted T waves
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BBB Recognition
Forget About the Notch!
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BBB Recognition
Wide QRS > 120ms
Supraventricular rhythm
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RBBB vs. LBBB
Use V1
Identify direction of
terminal force
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Bundle Branch Block
V1
Right Left
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BBB Recognition
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BBB Recognition
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RBBB vs. LBBB
LBBB distorts the 12 lead !!!
RBBB distorts the 12 lead but ST Elevation is real
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Vent. Paced Rhythms
Generally present like a LBBB
Pacer spikes
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Left Ventricular Hypertrophy
Enlarged left ventricle
Pumping against increased resistance
Chronic overfilling
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LVH
May Produce
ST elevation ST depression
Tall T waves
Inverted T waves
May Hide
ST elevation ST depression
Tall T waves
Inverted T waves
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LVH
Does not abnormally widen QRS
Increases height and depth of QRS
Recognized by this increase
Three step recognition formula
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LVH Recognition
Step 1
Look in V1 and V2
Pick the deepest negative deflection
Count small boxes of negative deflection in that
lead
Remember that number
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LVH Recognition
Step 2
Look in V5 and V6
Pick the tallest positive deflection
Count small boxes of positive deflection
Remember that number
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LVH Recognition
Step 3
Add the two numbers together
Suspect LVH if the sum equals 35 or
more
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LVH
(V1 or V2) + (V5 or V6) = _____mm
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Most Common Imitators
LBBB
PACED
LVH
SummarySummary