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12 LEAD ECG

Changes in Angina and

 Acute Myocardial Infarction

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OBJECTIVES

 To describe ECG changes in angina andAMI

to diferentiate the diferent types oinarct using a 12-lead ECG

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ANGINA

Coronary arteries are unable to deliver enough blooddue to narroing! platelet clu"ping! thro"busor"ation or vasospas"

#sually lasts 2 - 1$ "inutes

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Stable vs. Unstable Angina

%table - triggered by e&ertion ' relievedby rest or GT(

#nstable - pain co"es on easily ' getsorse) arning sign o i"pending AMI

*rugs - nitrates! beta bloc+ers! calciu"channel bloc+ers! ' aspirin to reduce

platelet aggregation

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ACUTE MYOCARDIAL INFARCTION

DEFINITION

 An occlusion of coronary arterial blood flow which results in a

necrotic area in the myocardium by :

Spasm of artery without atherosclerosis.

Spasm superimposed upon a lesion.

Clotting of artery that is stenosed.

Pain lasts for at least 2 minutes ! is unrelieved by rest .

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Damage of Zones

 An infarct which in"ol"es the full thic#ness of the

"entricular wall has $ %ones :

Central %one of necrosis &dead tissue' infarct.

(one of in)ury surrounding the necrotic area. (one of ischemia ne*t to the %one of in)ury.

+he 3 I’s of AMI produces characteristic ,C- changes

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ECG CHARACTERISTICS O A!I

,

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!"OCARDIAL NECROSIS

Q waves•are seen only in leads that face the infarcted area.

•may develop within an hour of an infarct a few dayslater.•!3 " wave.

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!#

$

$

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EVOLUTION O A!I

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!3

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!4

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!5

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Assessing A!I

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Diagnosis

Clinical "aniestation

%pecic cardiac en.y"es / "ar+ers

ECG

*iagnosis can be established hen toro" three criteria above are positip

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Management

0&ygen via nasal cannula or "as+

Medications

(itroglycerin sublingual or transder"al

dilates coronary arteries3 given only i 45 6 7$ "" 8g

Morphine narcotic-analgesic

Aspirin brea+s don the blood clot

9ignocaine or abnor"al ventricular arrhyth"ias