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ST depression in 2,3 avf is usually due to high lateral ST elevation (I, aVL) (although the STE may not be seen clearly, esp in aVF (QRS vector is perpendicular to aVF) , just ischemia
==ACS==
''See [[ACS]]''


Commonly held belief that you can localize where ischemia is when its ST depression is NOT true.... be more concerned that you're seeing reciprocal changes
==Aneurysm==
 
''see [[Left ventricular aneurysm]]''
 
*Suggested by:
ST segment elevation is relative to QRS size!
**ST elevation >4wk
 
**QS wave in setting of ST-segment elevation with out T-wave inversion
Early repol vs STEMI
- STEMI has longer QT interval, less R wave amplitude, and more ST elevation
- single best differentiator is R wave amplitude
-one of hallmarks of early repol is well formed R wave in V2-V4
-- if have QS wave + ST elevation must consider:
Old MI
vent aneurysm
subacute aneurysm 12hr old and R wave has disappeared
Cardiomyopathy
LVH
 
you can get qR waves immediately after MI - this does not mean that infarction has occurred and there's no point in reperfusion (that's what a QS wave means)
 
avL is the clue to whether the inf leads ST elevation represent inf MI or don't (ST depression OR TWI) ..... if you think this pt has an inf wall MI but there's nothing in aVL you're probably wrong
 
QRS > 200 think hyperK
 
 
 
 
==Arrythmias==
See Cards: Arrythmias (DDX)
 
==MI==
#T wave usu tracks w/ the QRS, thus if QRS primarily negative, twi is not necessarily abnl (nl twi in V1).
#ST elevation non-specific, also w/ LVH & strain, LBBB, CA spasm, pericarditis, "early repol", hyperK, dig/TCA's, CVA, Vent. aneurysm, hypothermia.
#Non-transmural: ST dep at least 1.0mm, twi.
#II, II, AVF for inf. MI
#V1-3 for anteroseptal inf.
#I, AVL, V4-6 for lat. wall inf.
#V1 or V2-6 anterolat.
#Large R and ST depression in V1-V2= POST. INFARCT! Post MI usu seen w/ inf MI b/c RCA supplies both in 90% of pts!
#Pts w/ inf. infarction +/or post wall mi often also have RV mi, need R sided leads!!
#STE >/= 1mm in V3R or V4R suggest RV MI!
#STE > 2wks= poss vent aneurysm!
#STE in avR and avL = LMA stenosis
#STE in avR and V1 = LAD or LMA stenosis
#if STE > 1.5 mm in avR pt has 75% mortality from AMI  --> activate cath lab (unless pt is in SVT, then STE is allowed)
 
===Infarct notes===
#inf wall: recip. In 1 and AVl. Downward sloping ST in AVl is often first sign.
#Any ST depression in V1 to V3 in a LBBB is pathological and suggestive of a post. Wall MI.
#Poor r waves progression-no r's by V4
#persistent t-wave elevation 6 wks post mi-vent. Anyeursm.anteroseptal with biphasic/inverted t wave


==Pericarditis==
==Pericarditis==
See [[Pericarditis#ECG]]
''See [[Pericarditis*[[ECG]]|Pericarditis]]''
 
 


==Electrolyte Disorders==
==Electrolyte Disorders==
===HyperK===
*[[Hyperkalemia]]
#5.5-6.6 -> tall peaked T, deep S in I and V6, QRS nml
*[[Hypokalemia]]
#7.0-8.0 -> QRS widens, slurred initial and term QRS, ST elevation, low wide P's, AV blocks, SA arrest, bradycardia.
*[[Hypercalcemia]]
#>8.0 -> widened QRS, Vfib, asystole.
*[[Hypocalcemia]]


===HypoK===
==CNS==
#3.0-3.5 no change or flat T' sand U's in V2-3, QT interval and QRS nml.
*[[SAH]], [[IC Bleed]], [[CVA]]
#2.7-3.0 U taller, T smaller, esp. V2-3
**Diffuse wide, deep, blunted, inverted T waves
#<2.6 ECG change includes tall U's, QT and QRS wnl.
**[[QT Prolongation]]


===HyperCa===
==Pacemakers==
#Increased QRS duration (slight)
''see [[Pacemaker complication]]''
#ST short or absent
*Should be in the apex of right ventricle
#Short corrected QT.
*[[ECG]] should mimic LBBB with LAD
#PR long
 
===HypoCa===
#slight decrease in QRS.
#ST and corrected QT long
#PR short.
#T's flat to inverted.


==CNS==
==Pulmonary Embolism==
#SAH, IC bleed, stroke, can see diffuse wide deep, blunted inverted T's. and QT prolonged
''see [[Pulmonary embolism]]''
*Sinus [[tachycardia]]
*S1Q3T3 (Sp, not Sn)
*Right axis deviation
*RBBB
*T wave inversions leads V1-V3


==Pacemakers==
==[[Hypothermia]]==
#Should be in the apex of R vent.
[[File:Osborn wave.gif|thumb]]
#ECG should mimic LBBB, w/ L axis.
*Osborn wave (J wave) - Positive deflection at the J point
**Height of the J wave correlates to the degree of hypothermia<ref>Vassallo SU, Delaney KA, Hoffman RS, et al. A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med. 1999; 6(11):1121-1126.</ref>
*Bradyarrhythmias, AV blocks
*Prolonged PR, QRS, QT intervals
*Shivering artifact


==PE==
==See Also==
#S1Q3T3
*[[ECG (Main)]]
##(good specificity, poor sensitiviy)
*[[STEMI equivalents]]


==Source==
==References==
DONALDSON 17/09 (Adapted from Niemann/Lampe)
<references/>


[[Category:Cards]]
[[Category:Cardiology]]

Latest revision as of 05:31, 22 March 2026

ACS

See ACS

Aneurysm

see Left ventricular aneurysm

  • Suggested by:
    • ST elevation >4wk
    • QS wave in setting of ST-segment elevation with out T-wave inversion

Pericarditis

See [[Pericarditis*ECG|Pericarditis]]

Electrolyte Disorders

CNS

Pacemakers

see Pacemaker complication

  • Should be in the apex of right ventricle
  • ECG should mimic LBBB with LAD

Pulmonary Embolism

see Pulmonary embolism

  • Sinus tachycardia
  • S1Q3T3 (Sp, not Sn)
  • Right axis deviation
  • RBBB
  • T wave inversions leads V1-V3

Hypothermia

Osborn wave.gif
  • Osborn wave (J wave) - Positive deflection at the J point
    • Height of the J wave correlates to the degree of hypothermia[1]
  • Bradyarrhythmias, AV blocks
  • Prolonged PR, QRS, QT intervals
  • Shivering artifact

See Also

References

  1. ↑ Vassallo SU, Delaney KA, Hoffman RS, et al. A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med. 1999; 6(11):1121-1126.
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