Myocardial infarction ecg

Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Symptoms include chest discomfort with or without dyspnea, nausea, and/or diaphoresis. Diagnosis is by electrocardiography (ECG) and the presence or absence of serologic markers. Treatment is antiplatelet drugs, anticoagulants, nitrates, beta-blockers, statins, and reperfusion therapy. For ST-segment-elevation myocardial infarction, emergency reperfusion is via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery. For non-ST-segment-elevation myocardial infarction, reperfusion is via percutaneous intervention or coronary artery bypass graft surgery. In the US, about 1.0 million myocardial infarctions occur annually. Myocardial infarction (MI) results in death for 300,000 to 400,000 people (see also Cardiac Arrest Cardiac arrest is the cessation of cardiac mechanical activity resulting in the absence of circulating blood flow. Cardiac arrest stops blood from flowing to vital organs, depriving them of... read more ). Acute MI, along with unstable angina, is considered an Overview of Acute Coronary Syndromes (ACS) Acute coronary syndromes result from acute obstruction of a coronary artery. Consequences depend on degree and location of obstruction and range from unstable angina to non–ST-segment elevation... read more . Acute MI includes both non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation my...

Causes of myocardial ischemia Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries). Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms. Symptoms Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include: • Neck or jaw pain • Shoulder or arm pain • A fast heartbeat • Shortness of breath when you are physically active • Nausea and vomiting • Sweating • Fatigue When to see a doctor Get emergency help if you have severe chest pain or chest pain that doesn't go away. Development of atherosclerosis If there's too much cholesterol in the blood, the cho...

Clinical Significance of Posterior MI Posterior infarction accompanies 15-20% of STEMIs, usually occurring in the context of an inferior or lateral infarction. • Isolated posterior MI is less common (3-11% of infarcts). • Posterior extension of an inferior or lateral infarct implies a much larger area of myocardial damage, with an increased risk of left ventricular dysfunction and death. • Isolated posterior infarction is an indication for emergent coronary reperfusion. However, the lack of obvious ST elevation in this condition means that the diagnosis is often missed. Be vigilant for evidence of posterior MI in any patient with an inferior or lateral STEMI. How to spot posterior infarction As the posterior myocardium is not directly visualised by the standard 12-lead ECG, reciprocal changes of STEMI are sought in the anteroseptal leads V1-3. Posterior MI is suggested by the following changes in V1-3: • Horizontal ST depression • Tall, broad R waves (>30ms) • Upright T waves • Dominant R wave (R/S ratio > 1) in V2 In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI. Typical appearance of posterior infarction in V2 Posterior infarction is confirmed by the presence of ST elevation and Q waves in the posterior leads (V7-9). Explanation of the ECG changes in V1-3 The anteroseptal leads are directed from the anterior precordium towards the internal surface of the posterior myocardi...

Under the current STEMI paradigm, 25-30% of NSTEMI patients are found to have total occlusion on delayed cardiac catheterisation. Using expert ECG interpretation instead of strict STEMI criteria, cardiologists are able to successfully reclassify 28% of NSTEMI patients as having acute coronary occlusion responsive to immediate reperfusion therapy, halving short- and long-term mortality In 2018, We utilise “STEMI criteria” in everyday practice but conveniently ignore the 2.5mm STE on the ECG of a 30-year-old male with benign sounding chest pain, whilst scrutinising over the trace STE in an 80-year-old female with ischaemic-sounding chest pain. The term “STEMI equivalent” is already in our vocabulary, but really it is referring to patients with clinical and ECG features concerning for acute coronary occlusion that would benefit from immediate percutaneous coronary intervention (PCI). ST depression in 2 or more precordial leads (V1-4) may indicate transmural posterior injury; multilead ST depression with coexistent ST elevation in lead aVR has been described in patients with left main or proximal LAD occlusion. Hyperacute T-wave changes may be observed in the early phase of STEMI, before the development of ST elevation. The What is an OMI? Occlusion Myocardial Infarction (OMI): A branch of the ACS algorithm representing near or total occlusion with insufficient collateral circulation causing active infarction Non-Occlusion Myocardial Infarction (NOMI): No occlusion, or suffici...

Clinical Significance of Posterior MI Posterior infarction accompanies 15-20% of STEMIs, usually occurring in the context of an inferior or lateral infarction. • Isolated posterior MI is less common (3-11% of infarcts). • Posterior extension of an inferior or lateral infarct implies a much larger area of myocardial damage, with an increased risk of left ventricular dysfunction and death. • Isolated posterior infarction is an indication for emergent coronary reperfusion. However, the lack of obvious ST elevation in this condition means that the diagnosis is often missed. Be vigilant for evidence of posterior MI in any patient with an inferior or lateral STEMI. How to spot posterior infarction As the posterior myocardium is not directly visualised by the standard 12-lead ECG, reciprocal changes of STEMI are sought in the anteroseptal leads V1-3. Posterior MI is suggested by the following changes in V1-3: • Horizontal ST depression • Tall, broad R waves (>30ms) • Upright T waves • Dominant R wave (R/S ratio > 1) in V2 In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI. Typical appearance of posterior infarction in V2 Posterior infarction is confirmed by the presence of ST elevation and Q waves in the posterior leads (V7-9). Explanation of the ECG changes in V1-3 The anteroseptal leads are directed from the anterior precordium towards the internal surface of the posterior myocardi...

Causes of myocardial ischemia Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries). Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms. Symptoms Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include: • Neck or jaw pain • Shoulder or arm pain • A fast heartbeat • Shortness of breath when you are physically active • Nausea and vomiting • Sweating • Fatigue When to see a doctor Get emergency help if you have severe chest pain or chest pain that doesn't go away. Development of atherosclerosis If there's too much cholesterol in the blood, the cho...

Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Symptoms include chest discomfort with or without dyspnea, nausea, and/or diaphoresis. Diagnosis is by electrocardiography (ECG) and the presence or absence of serologic markers. Treatment is antiplatelet drugs, anticoagulants, nitrates, beta-blockers, statins, and reperfusion therapy. For ST-segment-elevation myocardial infarction, emergency reperfusion is via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery. For non-ST-segment-elevation myocardial infarction, reperfusion is via percutaneous intervention or coronary artery bypass graft surgery. In the US, about 1.0 million myocardial infarctions occur annually. Myocardial infarction (MI) results in death for 300,000 to 400,000 people (see also Cardiac Arrest Cardiac arrest is the cessation of cardiac mechanical activity resulting in the absence of circulating blood flow. Cardiac arrest stops blood from flowing to vital organs, depriving them of... read more ). Acute MI, along with unstable angina, is considered an Overview of Acute Coronary Syndromes (ACS) Acute coronary syndromes result from acute obstruction of a coronary artery. Consequences depend on degree and location of obstruction and range from unstable angina to non–ST-segment elevation... read more . Acute MI includes both non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation my...

Under the current STEMI paradigm, 25-30% of NSTEMI patients are found to have total occlusion on delayed cardiac catheterisation. Using expert ECG interpretation instead of strict STEMI criteria, cardiologists are able to successfully reclassify 28% of NSTEMI patients as having acute coronary occlusion responsive to immediate reperfusion therapy, halving short- and long-term mortality In 2018, We utilise “STEMI criteria” in everyday practice but conveniently ignore the 2.5mm STE on the ECG of a 30-year-old male with benign sounding chest pain, whilst scrutinising over the trace STE in an 80-year-old female with ischaemic-sounding chest pain. The term “STEMI equivalent” is already in our vocabulary, but really it is referring to patients with clinical and ECG features concerning for acute coronary occlusion that would benefit from immediate percutaneous coronary intervention (PCI). ST depression in 2 or more precordial leads (V1-4) may indicate transmural posterior injury; multilead ST depression with coexistent ST elevation in lead aVR has been described in patients with left main or proximal LAD occlusion. Hyperacute T-wave changes may be observed in the early phase of STEMI, before the development of ST elevation. The What is an OMI? Occlusion Myocardial Infarction (OMI): A branch of the ACS algorithm representing near or total occlusion with insufficient collateral circulation causing active infarction Non-Occlusion Myocardial Infarction (NOMI): No occlusion, or suffici...

Clinical Significance of Posterior MI Posterior infarction accompanies 15-20% of STEMIs, usually occurring in the context of an inferior or lateral infarction. • Isolated posterior MI is less common (3-11% of infarcts). • Posterior extension of an inferior or lateral infarct implies a much larger area of myocardial damage, with an increased risk of left ventricular dysfunction and death. • Isolated posterior infarction is an indication for emergent coronary reperfusion. However, the lack of obvious ST elevation in this condition means that the diagnosis is often missed. Be vigilant for evidence of posterior MI in any patient with an inferior or lateral STEMI. How to spot posterior infarction As the posterior myocardium is not directly visualised by the standard 12-lead ECG, reciprocal changes of STEMI are sought in the anteroseptal leads V1-3. Posterior MI is suggested by the following changes in V1-3: • Horizontal ST depression • Tall, broad R waves (>30ms) • Upright T waves • Dominant R wave (R/S ratio > 1) in V2 In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI. Typical appearance of posterior infarction in V2 Posterior infarction is confirmed by the presence of ST elevation and Q waves in the posterior leads (V7-9). Explanation of the ECG changes in V1-3 The anteroseptal leads are directed from the anterior precordium towards the internal surface of the posterior myocardi...

Causes of myocardial ischemia Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries). Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms. Symptoms Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include: • Neck or jaw pain • Shoulder or arm pain • A fast heartbeat • Shortness of breath when you are physically active • Nausea and vomiting • Sweating • Fatigue When to see a doctor Get emergency help if you have severe chest pain or chest pain that doesn't go away. Development of atherosclerosis If there's too much cholesterol in the blood, the cho...