Stemi criteria
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The document provides criteria for diagnosing ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG). It lists cut-off values for ST elevation in different leads used to identify STEMI based on the patient's age, sex and lead location. It cautions that baseline ECG abnormalities like left bundle branch block (LBBB) could obscure interpretation and provides examples of STEMI in different heart locations identified by affected leads on ECG.
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WIDE QRS TACHYCARDIAhttps://aiimsbhubaneswar.nic.in/ 1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
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2. AVNRT is caused by a reentry circuit within the AV node, while AVRT involves an accessory pathway bypassing the AV node.
3. There are different subtypes of AVNRT and AVRT depending on which pathways are involved in the antegrade and retrograde directions. Typical AVNRT involves a slow-fast pathway while typical AVRT involves orthodromic conduction over an accessory pathway.
Ventricular tachycardia
Ventricular tachycardiaApollo Hospitals Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
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Brugada syndrome
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Lvh & rvh
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Left Bundle Branch Block (LBBB)
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- LBBB is diagnosed based on criteria including a QRS duration of over 120ms and abnormal ST segment and T wave patterns.
- The prognosis of LBBB depends on any underlying heart conditions, with LBBB increasing the risk of mortality. LBBB may resolve temporarily following a premature ventricular contraction due to resetting of the conduction system.
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- Ventricular arrhythmias including ventricular tachycardia and ventricular flutter.
- Irregular rhythms such as atrial fibrillation.
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Right and left ventricular hypertrophy
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Ecg changes in mi
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hocm.pptx
hocm.pptxakifab93 HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
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AVNRT
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AVNRT occurs when a reentry circuit forms within or just next to the atrioventricular node. The circuit usually involves two anatomical pathways: the fast pathway and the slow pathway, which are both in the right atrium. The slow pathway (which is usually targeted for ablation) is located inferior and slightly posterior to the AV node, often following the anterior margin of the coronary sinus. The fast pathway is usually located just superior and posterior to the AV node. These pathways are formed from tissue that behaves very much like the AV node, and some authors regard them as part of the AV node.
The fast and slow pathways should not be confused with the accessory pathways that give rise to Wolff-Parkinson-White syndrome (WPW syndrome) or atrioventricular reciprocating tachycardia (AVRT). In AVNRT, the fast and slow pathways are located within the right atrium close to or within the AV node and exhibit electrophysiologic properties similar to AV nodal tissue. Accessory pathways that give rise to WPW syndrome and AVRT are located in the atrioventricular valvular rings. They provide a direct connection between the atria and ventricles, and have electrophysiologic properties similar to ventricular myocardium.
STEMI Equivalent 
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Eisenmenger syndrome
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- Eisenmenger syndrome is defined as irreversible pulmonary hypertension caused by uncorrected congenital shunts between the systemic and pulmonary circulations.
- It can be caused by defects such as ventricular septal defects, atrial septal defects, and patent ductus arteriosus. Its presentation and progression depends on factors like the size and location of the defect.
- Patients typically experience symptoms like dyspnea, cyanosis, hyperviscosity, and right heart failure. Complications can include hemoptysis, stroke, and cerebral abs
Long QT Syndrome
Long QT SyndromeStanley Medical College, Department of Medicine 1) A 70-year-old woman presented with fever for 20-25 days and was found to have bradycardia and a prolonged QT interval, consistent with acquired prolonged QT syndrome.
2) She later developed ventricular tachycardia and cardiac arrest. Electrical cardioversion was required to restore sinus rhythm.
3) A temporary pacemaker was inserted and she was monitored in the intensive care unit. Her QT interval gradually normalized over the next few days with treatment.
EISENMENGER SYNDROME- PAUL WOOD
EISENMENGER SYNDROME- PAUL WOODDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
Aortic stenosis for post graduates
Aortic stenosis for post graduatesPROFESSOR DR. MD. TOUFIQUR RAHMAN A 63-year-old man presented with syncope, shortness of breath, and other symptoms for 2 years. Examination found dyspnea, tachycardia, low blood pressure, a systolic thrill, and left ventricular hypertrophy. Imaging showed severe aortic stenosis. The patient underwent transcatheter aortic valve implantation and is now doing well.
Brady arryhthmias
Brady arryhthmiasPraveen Nagula Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Stemi equivalents
Stemi equivalentsMohamed Hamoda 1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
Stemi equivalents
Stemi equivalentsMohamed Hamoda 1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
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- LBBB is diagnosed based on criteria including a QRS duration of over 120ms and abnormal ST segment and T wave patterns.
- The prognosis of LBBB depends on any underlying heart conditions, with LBBB increasing the risk of mortality. LBBB may resolve temporarily following a premature ventricular contraction due to resetting of the conduction system.
Tachyarrhythmias
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- Supraventricular tachycardias like atrial flutter, AV nodal reentrant tachycardia, and AV reentrant tachycardia.
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- Irregular rhythms such as atrial fibrillation.
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Systolic murmur
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Hypertrophic cardiomyopathy
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Mitral valve prolapse
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Right and left ventricular hypertrophy
Right and left ventricular hypertrophyRawalpindi Medical College Left ventricular hypertrophy is an increase in the mass of the left ventricle that can be caused by hypertension, hypertrophic cardiomyopathy, aortic stenosis, or athletic training. It is defined on an ECG as increased voltages in certain leads. Risk factors include age, gender, high blood pressure, obesity, and genetic factors. If left untreated, LVH can lead to heart failure, arrhythmias, heart attack, or sudden cardiac death. Right ventricular hypertrophy is the enlargement of the right ventricle and can be caused by pulmonary hypertension, congenital heart defects, or lung diseases. Both LVH and RVH are diagnosed using ECG criteria and can cause chest pain, palpitations
Ecg changes in mi
Ecg changes in miIndhu Reddy This document summarizes electrocardiogram (ECG) findings related to myocardial infarction (MI). It describes the ECG changes that occur in the hyperacute, evolved, and chronic phases of MI. These include ST segment elevation, T wave changes, Q wave development, and other abnormalities. It also discusses ECG patterns related to injury of specific coronary artery territories and criteria for diagnosing MI when a left bundle branch block is present.
hocm.pptx
hocm.pptxakifab93 HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Approach to bradyarrythmias1
Approach to bradyarrythmias1Bhargav Kiran This document discusses bradyarrhythmias and approach to treatment. It defines various types of sinus node dysfunction and AV conduction blocks including sick sinus syndrome, sinus pause, sinus arrest, tachy-brady syndrome, and different degrees of AV block. It describes evaluation of sinus node function including intrinsic heart rate, sinus node recovery time and SA conduction time. It discusses reversible and irreversible causes of bradyarrhythmias and guidelines for pacemaker implantation for sinus node and AV node dysfunction. Treatment options including medications and permanent pacing are outlined.
Sinus Node Dysfunction
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ARVD (Arrythmogenic right ventricular cardiomyopathy) - updated task force cr...
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Bundle branch blocks
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Stemi
Stemikazi alam nowaz The document discusses guidelines for the treatment of ST-elevation myocardial infarction (STEMI). It defines STEMI as a type of acute coronary syndrome where a completely occlusive thrombus results in total cessation of blood flow seen as ST elevation on an electrocardiogram. Immediate treatment goals for STEMI patients include pain control, rapid identification for reperfusion therapy, and avoiding inappropriate discharge. Initial emergency room management involves aspirin, clopidogrel, nitrates, morphine, and supplemental oxygen. Reperfusion options include fibrinolysis or primary percutaneous coronary intervention. Complications of STEMI can be early issues like cardiogenic shock or late problems like heart failure.
AVNRT
AVNRThttps://aiimsbhubaneswar.nic.in/ AV nodal reentrant tachycardia (AVNRT), or atrioventricular nodal reentrant tachycardia, is a type of tachycardia (fast rhythm) of the heart. It is a type of supraventricular tachycardia (SVT), meaning that it originates from a location within the heart above the bundle of His. AV nodal reentrant tachycardia is the most common regular supraventricular tachycardia. It is more common in women than men (approximately 75% of cases occur in females). The main symptom is palpitations. Treatment may be with specific physical maneuvers, medication, or, rarely, synchronized cardioversion. Frequent attacks may require radiofrequency ablation, in which the abnormally conducting tissue in the heart is destroyed.
AVNRT occurs when a reentry circuit forms within or just next to the atrioventricular node. The circuit usually involves two anatomical pathways: the fast pathway and the slow pathway, which are both in the right atrium. The slow pathway (which is usually targeted for ablation) is located inferior and slightly posterior to the AV node, often following the anterior margin of the coronary sinus. The fast pathway is usually located just superior and posterior to the AV node. These pathways are formed from tissue that behaves very much like the AV node, and some authors regard them as part of the AV node.
The fast and slow pathways should not be confused with the accessory pathways that give rise to Wolff-Parkinson-White syndrome (WPW syndrome) or atrioventricular reciprocating tachycardia (AVRT). In AVNRT, the fast and slow pathways are located within the right atrium close to or within the AV node and exhibit electrophysiologic properties similar to AV nodal tissue. Accessory pathways that give rise to WPW syndrome and AVRT are located in the atrioventricular valvular rings. They provide a direct connection between the atria and ventricles, and have electrophysiologic properties similar to ventricular myocardium.
STEMI Equivalent
STEMI Equivalent Rashid Abuelhassan This document provides an overview of various electrocardiogram (ECG) findings that can indicate acute myocardial infarction (AMI) or critical stenosis requiring intervention. It discusses ECG patterns seen in posterior MIs, left main coronary artery occlusions, De Winter's T waves, Wellen's syndrome, and Sgarbossa's criteria. Assessment of left ventricular ejection fraction is also reviewed, including fractional shortening, Simpson's method, and E-point septal separation. Limitations of certain methods in specific conditions are noted.
Eisenmenger syndrome
Eisenmenger syndromeKapil Vasanth This document provides an overview of Eisenmenger syndrome, including its definition, causes, classifications, modes of presentation, and treatment approaches. Some key points include:
- Eisenmenger syndrome is defined as irreversible pulmonary hypertension caused by uncorrected congenital shunts between the systemic and pulmonary circulations.
- It can be caused by defects such as ventricular septal defects, atrial septal defects, and patent ductus arteriosus. Its presentation and progression depends on factors like the size and location of the defect.
- Patients typically experience symptoms like dyspnea, cyanosis, hyperviscosity, and right heart failure. Complications can include hemoptysis, stroke, and cerebral abs
Long QT Syndrome
Long QT SyndromeStanley Medical College, Department of Medicine 1) A 70-year-old woman presented with fever for 20-25 days and was found to have bradycardia and a prolonged QT interval, consistent with acquired prolonged QT syndrome.
2) She later developed ventricular tachycardia and cardiac arrest. Electrical cardioversion was required to restore sinus rhythm.
3) A temporary pacemaker was inserted and she was monitored in the intensive care unit. Her QT interval gradually normalized over the next few days with treatment.
EISENMENGER SYNDROME- PAUL WOOD
EISENMENGER SYNDROME- PAUL WOODDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
Aortic stenosis for post graduates
Aortic stenosis for post graduatesPROFESSOR DR. MD. TOUFIQUR RAHMAN A 63-year-old man presented with syncope, shortness of breath, and other symptoms for 2 years. Examination found dyspnea, tachycardia, low blood pressure, a systolic thrill, and left ventricular hypertrophy. Imaging showed severe aortic stenosis. The patient underwent transcatheter aortic valve implantation and is now doing well.
Brady arryhthmias
Brady arryhthmiasPraveen Nagula Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
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Stemi equivalents
Stemi equivalentsMohamed Hamoda 1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
Stemi equivalents
Stemi equivalentsMohamed Hamoda 1) STEMI equivalents refer to patients with acutely occluded coronary arteries who do not present with classical ECG changes but have worse outcomes. Common equivalents include de Winter ST/T waves, Wellens' syndromes, ST elevation in aVR, new LBBB, isolated posterior MIs, and upright T waves in V1.
2) Wellens' syndromes present with progressive T wave inversions in leads V2-V3 and little cardiac marker elevation, indicating critical proximal LAD stenosis.
3) ST elevation in aVR with widespread ST depression indicates high-risk left main or three-vessel coronary disease requiring emergent angiography.
STEMI and Acute Coronary Syndromes
STEMI and Acute Coronary SyndromesRommie Duckworth This highly energetic lecture presents the pathophysiology of S-T elevation myocardial infarction in an easy to understand style to help you best identify, triage and treat patients presenting with acute coronary syndromes. Using the latest research behind the AHA Guidelines changes, AHA National Faculty Rom Duckworth will help you better coordinate with you partners along the continuum of cardiac care. Emphasis is placed on risk factors, recognizing truly sick patients and coordinating care with hospital personnel.
Learning Objectives: Students will learn:
-The pathophysiology of S-T elevation myocardial infarction.
-The difference between STEMI, NSTEMI and unstable angina.
-Differing treatment methods and priorities for different cardiac syndromes.
-The function and importance of 12 lead ECG and prehospital diagnostic testing.
-The roles and responsibilities of EMS providers as the key element in “door-to-balloon” and “door-to-needle” time for STEMI patients.
www.romduck.com
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American Heart AVOID study: Air Versus Oxygen In ST-elevation myocardial Infa...
American Heart AVOID study: Air Versus Oxygen In ST-elevation myocardial Infa...Emergency Live We’ve been waiting for the AVOID study, since we mentioned it a few years ago in another post on the harm of excessive oxygen. AVOID (Air Versus Oxygen in Myocardial Infarction). Now, it’s out. As expected, it shows that unnecessary oxygen supplement worsens outcome. The surprise is just how big a difference it makes! In this study, too much oxygen increased recurrent MI fivefold!
Avoiding hyperoxemia isn’t new. Normoxemia has been a trend, but lacked hard evidence in form of an RCT, and the reflex-O2-mask in ED has been hard to fight. Right now, the full AVOID article has yet to be released, but the results have just been presented at AHA’s congress in Chicago last week. And AHA has posted a video interview with Dr. Stub, one of the investigators of the AVOID trial, on the results, as well as posted his presentation slides here. This research performed an investigator initiated multicenter randomized controlled trial to compare supplemental oxygen therapy with no oxygen therapy in normoxic patients with STEMI to determine its effect on myocardial infarct size.
ORIGINAL SOURCE: http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_469664.pdf
King Bay ECG/STEMI
King Bay ECG/STEMIUFJaxEMS This document provides a summary of basics of electrocardiography (EKG/ECG) interpretation for emergency medicine. It begins with an overview of cardiac anatomy and the electrical conduction system. It then discusses components of the EKG including waves, intervals, rates, and rhythms. Common arrhythmias such as atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia are summarized. Interpretation of EKG findings including rates, rhythms, intervals, and morphologies are covered. The document concludes with a focus on ST-elevation myocardial infarction (STEMI) including location, treatment protocols, and example EKGs.
Recognition & management of bradycardia pediatrics AG
Recognition & management of bradycardia pediatrics AGAkshay Golwalkar This document provides an overview of bradycardia in children, including definitions, types, recognition, ECG characteristics, and management. It describes bradycardia as an abnormally slow heart rate for a child's age that can rapidly lead to cardiopulmonary compromise. The document outlines initial steps to stabilize a child with bradycardia, including checking for hypotension, decreased consciousness, shock, or respiratory distress. It also provides guidelines for determining the heart rate from an ECG and classifying different types of bradycardic rhythms like sinus bradycardia or heart block. Reversible causes of bradycardia are listed as well as an algorithm for treating symptomatic bradycardia with medications.
Ecg 101 with answers
Ecg 101 with answerschricres This document provides an overview of ECG interpretation. It discusses key elements like rhythm, axis, intervals, complexes and segments. Specific conditions are highlighted like inferior posterior STEMI and RV infarct. The importance of systematic analysis is emphasized. Pattern recognition, trends over serial ECGs and correlating findings with the clinical scenario are important skills. Confirming posterior STEMI with lateral precordial lead placement is advised. Overall it is a comprehensive guide to the fundamentals of ECG interpretation and applications in patient care.
ACLS algorithms 
ACLS algorithms Kerolus Shehata The document provides guidelines for treating cardiac arrest due to asystole or pulseless electrical activity (PEA). It outlines the pulseless arrest algorithm which involves checking the rhythm, performing CPR at 100 compressions per minute, establishing IV/IO access, administering epinephrine every 3-5 minutes, and treating potential reversible causes such as hypoxia, hypovolemia, hypothermia, tamponade, thrombosis, and toxins. For asystole, the priorities are high-quality CPR, identifying and correcting reversible causes, and considering termination of efforts if no electrical activity is present after initial treatment. For PEA, the best chance of return of spontaneous circulation is through quick treatment of reversible causes such
Cardiovascular Imaging
Cardiovascular ImagingMuhammad Ayub Non-invasive imaging plays an important role in the management of cardiovascular diseases. Different imaging modalities have advantages and limitations. Echocardiography is useful for assessing cardiac structure and function but limited for coronary artery disease evaluation. Nuclear imaging can evaluate perfusion and function but not coronary anatomy directly. CT and MRI can assess coronary anatomy in addition to function but CT involves radiation. The appropriate choice of imaging modality depends on the clinical question and no single test can replace all others for evaluating cardiovascular diseases. Integrating complementary information from different tests provides the most comprehensive assessment.
ECG in Emergency Department - Advances in ACS ECG
ECG in Emergency Department - Advances in ACS ECGDr.Mahmoud Abbas ECG in Emergency Department -Advances in ACS ECG. Lecture presented by Dr Hesham Ibrahim at the Egyptian Critical Care Summit , the leading educational event and medical exhibition in Egypt.
St elevation myocardial infarction
St elevation myocardial infarctionsalaheldin abusin This document defines STEMI and describes the presentation, diagnosis, and management of a patient experiencing an ST elevation myocardial infarction through electrocardiogram findings, fibrinolytic therapy, percutaneous coronary intervention, and post-procedure care. Reperfusion therapy options like fibrinolysis with streptokinase or alteplase and primary PCI are discussed. Guidelines for long-term secondary prevention with medications and lifestyle changes are also reviewed.
X-Ray in Heart diseases
X-Ray in Heart diseaseshttps://aiimsbhubaneswar.nic.in/ This document discusses the stages of pulmonary edema seen on chest x-rays and associated wedge pressures. Stage I shows early signs like deer antler sign and Kerley B lines with pressures of 12-18 mmHg. Stage II shows interstitial edema on x-ray with pressures of 19-25 mmHg. Stage III is alveolar edema appearing as bat wing shadowing on x-ray associated with pressures over 25 mmHg.
ACC/AHA 2013 STEMI GUIDELINES - SUMMARY & NEW ADDITIONS
ACC/AHA 2013 STEMI GUIDELINES - SUMMARY & NEW ADDITIONSImran Ahmed The 2013 ACCF/AHA Guideline for the Management of STEMI provides recommendations for reperfusion therapy. It recommends that patients with cardiogenic shock or severe heart failure be transferred for immediate cardiac catheterization. It also recommends ECG assessment by emergency medical services. Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 12-24 hours of symptom onset. The guidelines recommend the use of drug-eluting stents in primary PCI and antiplatelet therapy to support PCI. It also provides recommendations for fibrinolytic therapy, PCI after fibrinolysis, and adjunctive antithrombotic therapies.
2015 ESC NSTEMI guidelines
2015 ESC NSTEMI guidelinesPlease hit like if you really liked my PPTs Anginal pain in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can present in several ways, including prolonged chest pain at rest lasting over 20 minutes, new onset chest pain classified as Canadian Cardiovascular Society class II or III, recently destabilized previously stable angina with class III characteristics, or chest pain following a myocardial infarction. The document provides recommendations on diagnosis, treatment strategies, timing of invasive procedures, and long-term management of patients presenting with NSTE-ACS.
Acute coronary syndrome(STEMI GUIDELINES AND RECENT ADVANCES)
Acute coronary syndrome(STEMI GUIDELINES AND RECENT ADVANCES)Aditya Sarin This document summarizes guidelines for the management of ST-elevation myocardial infarction (STEMI). It discusses epidemiology trends showing declining incidence of STEMI but increasing non-ST elevation ACS. Key recommendations include establishing regional STEMI systems, performing primary percutaneous coronary intervention (PCI) over fibrinolysis when possible within 120 minutes of first medical contact, and giving antiplatelet therapies like aspirin, clopidogrel, prasugrel, or ticagrelor to support primary PCI. Recent advances in thrombus aspiration, drug-eluting stents, and antiplatelet agents are also summarized.
Chest x ray pathology
Chest x ray pathologyhai2all2000 yahoo The document provides an overview of the pathology of lung diseases as seen on chest x-rays, including signs, appearances and common causes of conditions such as consolidation, pleural effusion, atelectasis, pneumothorax, lung masses, fibrosis and infections like tuberculosis. Differential diagnoses are also provided for various lung abnormalities seen on x-rays.
Localization of MI on ECG
Localization of MI on ECGNooh Khushal The document discusses localization of myocardial ischemia, injury, and infarction based on electrocardiogram (ECG) findings. It provides information on interpreting ST segment changes and T-wave abnormalities in different leads to localize occlusion in the left anterior descending, right coronary artery, or left circumflex arteries. Reciprocal changes are also discussed as indicators of occlusion location.
Diagnostic radiology of cardiovascular 2009
Diagnostic radiology of cardiovascular 2009Sumit Prajapati This document summarizes diagnostic radiology techniques for imaging the cardiovascular system. It describes normal appearances and abnormalities seen on x-rays, CT, MRI, echocardiography and nuclear medicine imaging. Key sections outline normal cardiac anatomy and sizes seen on x-ray, as well as abnormalities such as heart enlargement, pulmonary blood flow changes, aortic abnormalities like aneurysms and dissections. Imaging methods for evaluating these conditions are also mentioned.
basics of chest X- ray interpretation
basics of chest X- ray interpretationMaha Yousif This document discusses chest x-ray interpretation and provides guidance on evaluating x-rays. It explains that tissue density determines how an x-ray beam penetrates, with denser tissues appearing whiter and less dense tissues appearing blacker. It also outlines different chest x-ray views and factors to consider like patient orientation, age, gender, and rotation. Abnormalities are described as appearing too white, too black, too large, or in the wrong place. The document stresses a systematic approach of identifying, localizing, describing lesions, and providing differential diagnoses.
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ECG: LBBB and Acute MI
ECG: LBBB and Acute MIStanley Medical College, Department of Medicine The document discusses an ECG of a 75-year-old female patient presenting with chest pain. The initial ECG showed left bundle branch block (LBBB) and signs of an acute myocardial infarction (MI) in the left anterior descending artery. A repeat ECG after 24 hours showed signs of left ventricular hypertrophy and anterior and inferior wall ischemia. The document then discusses various criteria for diagnosing MI in patients presenting with LBBB, including the Sgarbossa criteria. It also describes different subtypes and variants of LBBB that can complicate the diagnosis of MI.
ECGcheatsheet52.pdf
ECGcheatsheet52.pdfTirumalaRao41 The document provides guidance on electrocardiogram (ECG) interpretation, including how to identify abnormalities related to hypertrophy, rhythm, rate, axis deviation, ST segments, T waves, and myocardial infarction patterns. Key signs of left atrial enlargement include a P wave duration over 0.12 seconds in lead II and bifid P waves. Right atrial enlargement presents as a P wave amplitude over 0.25mV in lead II. Pathological Q waves indicate prior myocardial infarction. ST segment elevation in two contiguous leads of over 0.1mV (or higher thresholds in some leads) suggests acute ischemia.
ECG IN STEMI.ppt
ECG IN STEMI.pptcmarosdi This document discusses the role of electrocardiograms (ECGs) in diagnosing ST-segment elevation myocardial infarction (STEMI). It describes how ECGs can be used to:
1) Diagnose acute STEMI based on specific ST elevation patterns and cardiac marker changes.
2) Determine candidates for reperfusion therapy.
3) Assess the success of reperfusion therapy by observing the resolution of ST elevation.
It then outlines the typical ECG patterns seen in different types of STEMI based on the affected coronary artery.
ST SEGMENT IN ECG,ST ELEVATION AND ST DEPRESSION
ST SEGMENT IN ECG,ST ELEVATION AND ST DEPRESSIONDR Venkata Ramana The document discusses the ST segment of the ECG and various abnormalities that can occur. It notes that the ST segment represents the interval between ventricular depolarization and repolarization. ST segment elevation or depression can indicate myocardial ischemia or infarction. Various conditions are described that can cause ST segment changes, including myocardial infarction in different coronary artery territories, coronary vasospasm, pericarditis, early repolarization, and others. The morphology and patterns of ST segment abnormalities are discussed for evaluating these conditions.
Mi in lbbb i.tammi raju
Mi in lbbb i.tammi rajuTammiraju Iragavarapu This document discusses the diagnosis of myocardial infarction (MI) in the presence of bundle branch blocks. It notes that bundle branch blocks can make ECG diagnosis of MI more difficult by altering depolarization patterns. For right bundle branch block, the criteria for diagnosing a Q-wave MI are the same as normal conduction. For left bundle branch block, the Sgarbossa criteria (ST elevation concordant with QRS, ST depression in V1-V3, discordant ST elevation ≥5mm) have high specificity but low sensitivity for acute MI diagnosis. Certain ECG patterns like abnormal Q waves may suggest prior infarction despite left bundle branch block.
LBBB
LBBBAswin Rm 1. Left bundle branch block (LBBB) is a conduction abnormality caused by impaired conduction in the left bundle branch or its fascicles.
2. LBBB can be chronic or intermittent and is often caused by coronary artery disease or hypertension.
3. On ECG, LBBB is characterized by a QRS duration ≥120ms and other abnormalities including broad R waves and abnormal ST-T wave patterns.
4. LBBB can make ECG diagnosis of myocardial infarction difficult and criteria like Sgarbossa scores are used to help identify MI in the setting of LBBB.
Lethal ECG pattern reading and diagnosis.pptx
Lethal ECG pattern reading and diagnosis.pptxHussein Alwais This document contains a series of ECGs with clinical scenarios and questions. It discusses various cardiac conditions that can be diagnosed based on abnormalities seen on ECGs, including hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, arrhythmogenic right ventricular dysplasia, hyperkalemia, sodium channel blockade, Brugada syndrome, myocardial infarction, and pericardial effusion. The document uses ECGs to test the reader's ability to identify key abnormalities and determine the underlying cardiac diagnosis suggested by the ECG pattern.
Part 1 ecg 2019 slide share
Part 1 ecg 2019 slide sharehospital The document provides an overview of how to read and interpret electrocardiograms (ECGs). It discusses the normal conduction system including the sinoatrial node, atrioventricular node, and bundle of His. It describes lead placement and what different leads represent. It outlines the 10 rules for a normal ECG, including details on intervals, wave directions, and segment morphologies. It also discusses axis determination and provides examples of calculating heart rate from the ECG tracing.
2 Minute 12 Leads V5
2 Minute 12 Leads V5John Bray The document discusses how to obtain and interpret a 12-lead electrocardiogram (ECG) to diagnose acute myocardial infarction (AMI), explaining the anatomy, waveform components, localization of ST elevations, and reciprocal changes seen with different types of AMI such as inferior, anterior, lateral, and posterior infarcts. It emphasizes that ST elevation is the most important indicator of AMI and timely treatment is critical, as AMI appears within 1-2 hours on ECG and delays increase damage. Bundle branch blocks and other conditions can obscure ECG findings, so new or presumed new bundle branch blocks are treated as potential AMI.
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ECG LOCALIZTION OF CULPRIT VESSEL IN MI.pptxruhailbhat ECG Localization of culprit vessel i myocardial infraction
Ecg that you cannot missed as emergency doctors
Ecg that you cannot missed as emergency doctorsssusere8a415 Just a summary about ecgs that you must not missed while practicing in ed
TCAD - Multi-lead ECG
TCAD - Multi-lead ECGTCADClinical This document provides guidance on performing and interpreting multi-lead electrocardiograms (ECGs). It aims to improve patient outcomes by reducing time to percutaneous coronary intervention through early ECG acquisition and transmission. Proper lead placement is emphasized for 12- and 15-lead ECGs. A systematic approach to ECG interpretation is outlined, including identifying the underlying rhythm, assessing the axis and potential hemiblocks or bundle branch blocks, using the ISAL method to determine infarct location, and evaluating for atrial abnormalities. Key waves, intervals, and criteria for identifying ventricular tachycardia, ischemia, injury, and infarction are defined.
Making Sense Through series of ECG signs.pptx
Making Sense Through series of ECG signs.pptxSadanand Indi bundle branch blocks with LBBB and diagnosis of Myocardial infarction
Indiana ENA 2013 Lead aVr
Indiana ENA 2013 Lead aVrAndrew J Bowman Lead aVr on EKGs is often overlooked but can provide important information. STE in lead aVr along with other leads could indicate LMCA stenosis or proximal LAD stenosis, suggesting acute coronary syndrome requiring emergent treatment. STE in aVr with SVT may indicate Wolff-Parkinson-White syndrome. VT can be distinguished from SVT in wide complex tachycardia based on the morphology in lead aVr. Lead aVr may also demonstrate findings suggestive of pericarditis or tricyclic antidepressant overdose. Careful examination of lead aVr is encouraged to identify potentially life-threatening conditions.
3rd part ECG Basics QRS complex Dr Salah Mabrouk Khallaf
3rd part ECG Basics QRS complex Dr Salah Mabrouk KhallafDr Salah Mabrouk Khallaf This document provides an overview of QRS complexes and abnormalities seen on electrocardiograms (ECGs). It defines the components of the QRS complex and discusses causes of low or high voltage QRS complexes. Specific conditions that can cause left or right ventricular hypertrophy are described. Various conduction abnormalities are also summarized, including right and left bundle branch blocks, fascicular blocks, and bifascicular blocks. Causes of wide QRS complexes like hyperkalemia and certain drugs are mentioned. The document aims to educate on interpreting and analyzing QRS complexes on ECGs.
STEMI Mimic WHAT IS IT AND HOW TO IDENTIFY IT ?
STEMI Mimic WHAT IS IT AND HOW TO IDENTIFY IT ?Haitham Habtar The document discusses several STEMI mimics that can present with ST segment elevation on ECG but are not actually caused by an acute myocardial infarction. These include early repolarization, left bundle branch block, electrolyte abnormalities, left ventricular hypertrophy, pulmonary embolism, left ventricular aneurysm, Brugada syndrome, pericarditis, and hypothermia. It provides details on the characteristic ECG patterns and clinical features that can help differentiate these conditions from a true STEMI.
Topik 3 - ECG in ACS, chamber dilation and special conditions.pdf
Topik 3 - ECG in ACS, chamber dilation and special conditions.pdfanggelinathendry Explanatiin about ECG in ACS patient
Electrocardiogram in myocardial infarction 
Electrocardiogram in myocardial infarction https://aiimsbhubaneswar.nic.in/ In a myocardial infarction transmural ischemia develops. In the first hours and days after the onset of a myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves and finally pathologic Q waves develop.
Bundle branch blocks by Dr Sujith Chadala
Bundle branch blocks by Dr Sujith ChadalaDr Sujith Chadala Right bundle branch block,Left bundle branch block,Fasicular blocks,Intraventricular conduction blocks,hemiblocks,bifasicular blocks,trifasicular blocks,qRBBB ecg,causes of rbbb,causes of lbbb,Sgarbossa criteria,incomplete blocks,LAFB,LPFB,RAD,LAD
Ecg Part 1
Ecg Part 1hospital The document discusses electrocardiography (ECG) and how it is used to diagnose myocardial infarction (MI). It provides details on:
1) How 12 leads are used to view the heart electrically from different angles and locations, and which 10 electrodes are used.
2) The typical signs seen on an ECG during an MI, including ST segment elevation, pathological Q waves, reduced R waves, and inverted T waves.
3) The sequence of ECG changes that occur during an evolving MI, from initial onset through later stages.
4) How different leads on the ECG can indicate the location of an infarct, such as anterior vs inferior walls.
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Random ECGs 2
Random ECGs 2chricres 1. The document contains a series of ECG interpretations and management plans provided by Dr. Chris Cresswell for various patient presentations including chest pain, altered mental status, palpitations, and cardiac arrest.
2. Cases involve interpreting ECGs for conditions like STEMI, hyperkalemia, ventricular arrhythmias, Wolff-Parkinson-White syndrome, and atrial flutter.
3. Management plans focus on revascularization, electrolyte abnormalities, electrical cardioversion, antiarrhythmics, and other treatments depending on the patient's condition and ECG findings.
Random ECGs 1
Random ECGs 1chricres This document contains summaries of ECG findings for various patients. Key cases include:
- A 95-year-old patient with faintness and a systolic murmur, whose ECG and murmur were suggestive of critical aortic stenosis.
- A 13-year-old with sudden palpitations found to have sinus tachycardia from rheumatic fever.
- A 10-year-old Māori boy with joint pain and swelling found to have myocarditis from acute rheumatic fever, shown on his ECG.
- A 35-year-old with chest pain and palpitations found to have Wolff-Parkinson-White syndrome.
The document
Blood gases for nurses
Blood gases for nurseschricres The document discusses several cases presenting with blood gas results. Case 1 shows a patient with diabetic ketoacidosis or hyperosmolar hyperglycemic state with relative hypoxia and hypoperfusion. Case 2 has a patient with life-threatening hyperkalemia, hypoxia, and severe acidosis requiring treatment. Case 3 is a toddler with gastroenteritis and life-threatening hypokalemia needing IV potassium replacement.
Introduction to head ct
Introduction to head ctchricres This document discusses various types of head injuries and conditions that appear on CT scans of the head. It describes acute subdural hematomas, which can cause midline shift. It also mentions chronic and subacute subdural hematomas, extradural hematomas, subarachnoid bleeds from trauma or aneurysms, and intraventricular hemorrhages that are usually secondary to hypertension. The document provides guidance on evaluating ring enhancing lesions and old lacunar or cortical infarcts. It concludes with general care recommendations for acute head injuries, such as maintaining normal oxygen, carbon dioxide, hydration and avoiding pressure areas.
Blood gases. Worked examples
Blood gases. Worked exampleschricres This patient presents with respiratory alkalosis and hypokalemia. They likely have a primary respiratory pathology causing hyperventilation and respiratory alkalosis. The hypokalemia needs urgent repletion through an IV route given its severity. The underlying cause of the respiratory issue needs to be determined through further history, exam, and testing to guide appropriate treatment and management.
Lbbb + sgarbossa
Lbbb + sgarbossachricres The document discusses the Law of Discordance for left bundle branch block (LBBB), stating that in a normal LBBB the ST segments should be isoelectric or go in the opposite direction from the dominant part of the QRS. It then outlines the Modified Sgarbossa Criteria for diagnosing STEMI in the presence of LBBB, including concordant ST changes or discordant ST elevation greater than 1/4 the amplitude of the S wave. Finally, it notes that these criteria also apply to ventricular paced rhythms and stresses the importance of documentation for ECG interpretations.
Military trauma
Military traumachricres This document discusses principles of combat casualty care, including:
1. The goals of Tactical Combat Casualty Care (TCCC) are to save preventable deaths, prevent additional casualties, and complete the mission.
2. About 60% of combat deaths are from hemorrhage from extremity wounds, 33% from tension pneumothorax, and 6% from airway obstruction - all of which can potentially be prevented with the right interventions.
3. There are three categories of casualties on the battlefield - those who will live regardless, those who will die regardless, and those who could be saved from preventable deaths with proper medical intervention. The goal is to target interventions to the correct mechanisms
Mass casualty and hazardous substances 2014
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Rmo mil trauma
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1. The goals of Tactical Combat Casualty Care (TCCC) are to save preventable deaths, prevent additional casualties, and complete the mission.
2. About 60% of combat deaths are from hemorrhage from extremity wounds, 33% from tension pneumothorax, and 6% from airway obstruction - all largely preventable causes if immediate lifesaving interventions are provided on the battlefield.
3. There are three categories of casualties - those who will live regardless, those who will die regardless, and those who could be saved by timely intervention to stop hemorrhage, relieve airway obstruction, or treat tension
Sumatra assist1
Sumatra assist1chricres The document discusses the medical response to the 2004 Indian Ocean tsunami in Sumatra, Indonesia. It notes that Australian medical teams performed over 270 operations in 6 weeks, with a third of cases not related to the tsunami and a third involving dressings and other treatments. The majority of acute cases were seen in the first 3 weeks, and medical issues included 93 cases of tetanus, with 30% of those experiencing aspiration pneumonia. Tuberculosis was also highly prevalent.
Ct head, nz_guidelines,_ed_presentation
Ct head, nz_guidelines,_ed_presentationchricres This document summarizes guidelines for head CT scans in adults and children presenting to the emergency department with head trauma. It outlines criteria for when to CT scan based on factors like Glasgow Coma Scale score, loss of consciousness, age, mechanism of injury, vomiting, and neurological symptoms. It also provides recommendations for when to perform a repeat CT scan if symptoms worsen or change. The guidelines aim to identify clinically significant traumatic brain injuries requiring intervention while avoiding unnecessary radiation exposure from CT scans.
ECG 101
ECG 101chricres The ECG provides a window into the heart, lungs, electrolytes, body temperature and sometimes the brain. It is important to systematically interpret the ECG by examining features like the rate, rhythm, axes, QRS complex, ST segment, T waves and QTc interval. Interpreting ECGs helps identify conditions like myocardial ischemia, electrolyte imbalances and long QT syndrome. It is important to record the time and name on the ECG and order repeat ECGs as needed to monitor patients.
Anaphylaxis. Dr Tom Francis
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Obstetric emergency communication and teamwork
Obstetric emergency communication and teamworkchricres The document discusses effective communication and teamwork during obstetric emergencies. It emphasizes the importance of clear leadership, role assignment, situation awareness, and closed-loop communication to ensure procedures are performed quickly and lead to better outcomes for mother and baby. Key aspects of managing emergencies as a team include mindful focus, declaring the situation, assigning a leader, providing handovers, voicing a shared plan of action, and managing any disagreements constructively.
Swarm based medical education
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Stemi criteria
- 1. STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
- 3. 3rd Universal Definition of MI (2012)
- 4. STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
- 5. General pitfalls • Beware of baseline ECG abnormalities that may obscure interpretation • LBBB • refer to Sgarbossa’s criteria • LVH • J-point elevation syndromes eg, Brugada • PE • Peri/myocarditis • Cardiomyopathy, including Takotsubo • Cocaine use • Cardiac pacing
- 6. STEMI location • septal • V1, V2 • inferior • II, III, aVF • reciprocal changes: I, aVL • lateral • I, aVL, V5, V6 • reciprocal changes: II, III, aVF • anterior • V3, V4 • anteroseptal • V1, V2, V3, V4 • anterolateral • I, aVL, V3, V4, V5, V6 • reciprocal changes: II, III, aVF • posterior • V7, V8, V9 • reciprocal changes: V1, V2, V3, V4
- 9. ECG 3 Inferolateral STEMI + Horizontal ST depression V1-3 + Tall R waves, upright T-waves V2-3
- 10. ECG 3 + posterior leads Inferior-lateral-posterior STEMI
- 11. References • Bax, Jeroen J., et al. "Third Universal Definition of Myocardial Infarction." Journal of the American College of Cardiology 60.16 (2012): 1581-1598.