Basic 1-hr 12l

Transcript

What is different? What is different? Plaque Rupture Lipid Core Fibrous Cap Lumen Thrombus Formation Lipid Core Fibrous Cap Platelets Adhere Thrombus Formation Platelet Aggregation Lipid Core Thrombus Formation Platelet Aggregation Lipid Core Fibrin Vasoconstriction Anatomy of the Heart The layers of the heart muscle Epicardium (outer most) Endocardium (inner most)   Myocardium (muscle mass)   Evolution of Myocardial Infarction A Dynamic Process ST Segment Elevation “     The hallmark of Myocardial Injury ”       ST Segment Depression “     Myocardial Ischemia ”       Inverted T waves “     Myocardial Ischemia ”       STEMI Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6       What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? = STEMI What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   What is the underlying rhythm? Imitators? (LBBB, Pacer, LVH) if yes = STOP!   Look at each pattern systematically: • ST elevation (1mm or more) = STEMI • ST depression (1mm or more) = ISCHEMIA • Inverted T waves = ISCHEMIA Need changes in two or more leads in a pattern Which pattern or patterns are involved? Lead Placement How the Leads view the Heart   I   II   III   aVF   aVL   Limb Leads   Chest Leads   Basic Patterns   1   2   3   4   5   6   Questions Summary  12 lead interpretation is about pattern recognition  Use a systematic approach to interpretation  ST Elevation (STEMI) trumps other ACS finding  It’s an art..Practice makes perfect