Professional Documents
Culture Documents
beginners – 2
RZ Tienen
UZ Leuven
INFLUENCE OF TIME-TO-TREATMENT ON 3
THE ODDS RATIO (OR) OF MORTALITY
80
60
1,000 patients treated when the treatment is THROMBOLYSIS IN
initiated within the first hour of symptom onset! CLINICAL TRIALS
AND REGISTRIES
NEW TRIALS/
ABSOLUTE BENEFIT PER
REGISTRIES
1,000 TREATED PATIENTS
40 MANAGEMENT
OF ACUTE MI AND
THE RATIONALE
FOR EARLY
REPERFUSION
20 CLINICAL
QUESTIONS
METALYSE
(+ PRESCRIBING
INFORMATION)
0 COSTS
0 3 6 9 12 15 18 21 24
REFERENCES
IMPRESSUM
A heart
• Blood circulates, passing near
every cell in the body, driven by this
pump
• …actually, two pumps…
• Atria = turbochargers
• Myocardium = muscle
• Mechanical systole
• Electrical systole
Excitation of the Heart
Excitation of the Heart
Cardiac Electrical Activity
A system
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
A system
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
P wave
• Are there P waves….?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
QRS complex
• Should be <0.12s duration
• >0.12s = BBB (either LBBB or RBBB)
W I LL ia M = LBBB
M a RR o W = RBBB
QRS complex
Is there LVH?
Sum of the Q or S wave in V1 and the biggest R
wave in V5 or V6 >35mm
(R wave in aVL >11mm)
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
ST segment
ST depression
◦ Downsloping or horizontal = abnormal
◦ Ischaemia (coronary stenosis)
◦ If lateral (V4-V6), consider LVH with ‘strain’ or digoxin (reverse
tick sign)
ST elevation
◦ Infarction (coronary occlusion)
◦ Pericarditis (widespread)
• No pot, no tea!
QT interval
Don’t worry about too much…
Hypertrofie
Voorkamer en Kamer
K51 – Rechter voorkamerhypertrofie
• Dilatatie van de rechter voorkamer
• Hoge spitse P toppen in afl. II & aVF ( 0,25 mV)
• Toename initiële P voltage in afl. II, III, aVF & V1
• Normale duur P golf
• Vaak in combinatie met tekenen van rechter kamerhypertrofie
P pulmonale
K52 - Linker voorkamerhypertrofie
• Dilatatie van de linker voorkamer
• P golf > 120 ms
• Gehaakte P top door toename amplitude terminaal deel van P golf in afl. I,
II, aVL & V6
• Bifasische P golf in afl. V1 met terminaal negatief deel ( 0,1 mV, 40 ms)
LVH ECHOcardiogram
Increased QRS voltage
For more presentations
www.medicalppt.blogspot.com
Left Ventricular Hypertrophy
• Criteria exists to diagnose LVH using a 12-lead ECG.
– For example:
• The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35
mm.
• Late change
R
ST
• Occurs as ST elevation is
P returning to normal
• Apparent in many leads
T
Q
Bundle branch block
Anterior wall MI Left bundle branch block
I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6
Sequence of changes in evolving AMI
R
R R
ST ST
T
P P P
T
Q S Q
Q
1 minute after onset 1 hour or so after onset A few hours after onset
ST T
P P ST
P
T T
Q Q Q
Left
coronary
artery
Inferior infarction
Inferior infarction
Right
coronary
artery
Lateral infarction
Lateral infarction
Left
circumflex
coronary
artery
Location of infarct combinations
I aVR V1 V4
ANT
LATERAL
POST ANT
II aVL V2
SEPTAL
V5
ANT
V3 V6 LAT
III aVF
INFERIOR
Diagnostic criteria for AMI