心肌缺氧及梗塞
-J point: junction between the end of QRS and
beginning of the ST segment
-ST segment: J-Point and beginning of T wave
-Need reference point: Compare to TP segment,
DO NOT use PR segment as reference!
ECG導極ST elevation反映MI位置
-Inferior wall: II, III, aVF
-Lateral wall: I, aVL, V5-V6
-Anterior wall: V3,V4
-Right ventricular: V4R,V5R
-Posterior wall: R/S ratio>1 in V1&V2
1.ECG導極ST elevation反映MI位置
2.有鏡像ST depression(不一定)
3.隨時間變化
minutes: hyperacute T<4h: ST segment elevation
4-6h: Q wave formation& loss of R wave
16-24h: T wave inversion
weeks: Q wave persist
-.*reciprocal change不一定會有
.-STEMI的診斷標準
1.肢體導程:ST elevation>=1mm(0.1mV)
2.胸前導程:ST elevation >=2mm(0.2mV)
3.且ST elevation必須在解剖構造對應的至少2個導程皆出現
下壁梗塞
右冠狀動脈
-Inferior wall: II, III, aVF
-recirprocal change in 前側&左外側
*aVL的T波倒置是下壁梗塞中特別常見的變化,甚至可能是第一個徵兆
下壁梗塞記得做右側ekg
側壁梗塞
左迴旋支
-Lateral wall: I, aVL, V5-V6
-reciprocal change:下壁導極
前壁梗塞
左前降支
-Anterior wall: V3,V4,若影響到septal wall:V1,V2
-Loss of R Wave progression
定義:
-reciprocal change:下壁導極
後壁梗塞
-Posterior wall: V1&V2:ST depression :question:
-Ischemic ST depression in V1 and V2 due to ACS is posterior STEMI until proven otherwise.
-把心電圖倒過來看
-常伴隨下壁梗塞
V1 or V2突出之R波的D.D.
右心室肥厚
RBBB
WPW
後壁心肌梗塞
右心室梗塞
1.總是伴有下壁梗塞,右側ECG確認:,V4R STE
2.怎麼看右側EKG:V4-6沒有R 波
RV infarction:給水(hydration)
LV infarction: mechanical support
NSTEMI
Takotsubo Cardiomyopathy
心絞痛
變異型心絞痛prinzmetal angina