The different infarct patterns are named according to the leads with maximal ST elevation:
- Septal = V1-2
- Anterior = V2-5
- Anteroseptal = V1-4
- Anterolateral = V3-6, I + aVL
- Extensive anterior / anterolateral = V1-6, I + aVL
What are the characteristics of acute anterolateral mi?
Acute anterolateral MI. Acute anterolateral MI is recongnized by ST segment elevation in leads I, aVL and the precordial leads overlying the anterior and lateral surfaces of the heart (V3 - V6). Generally speaking, the more significant the ST elevation , the more severe the infarction. There is also a loss of general R wave progression across...
What ECG findings are characteristic of anterolateral infarction?
There is also subtle ST elevation in the high lateral leads (I and aVL); this may be easily missed. However, the presence of reciprocal ST depression in the inferior leads (III and aVF) makes the lateral ST elevation more obvious. This ECG represents the early stages of a large anterolateral infarction.
What do QS waves in the anteroseptal leads indicate?
QS waves in the anteroseptal leads (V1-4) with poor R wave progression indicate prior anteroseptal infarction. This pattern suggests proximal LAD disease with an acute occlusion of the first diagonal branch (D1). There is subtle ST elevation in the high lateral leads (I and avL).
What is the difference between inferior limb leads and lateral limb leads?
Lead II, aVF and III are called inferior limb leads, because they primarily observe the inferior wall of the left ventricle ( Figure 18, coordinate system in upper panel ). Lead aVL, I and –aVR are called lateral limb leads, because they primarily observe the lateral wall of the left ventricle.
What is anterolateral in ECG?
Anterolateral myocardial infarction (MI) is traditionally defined on the electrocardiogram by ST‐elevation (STE) in I, aVL, and the precordial leads. Traditional literature holds STE in lead aVL to be associated with occlusion proximal to the first diagonal branch of the left anterior descending coronary artery.
Which ECG leads are anterior?
Anterior leads = V3-4. Lateral leads = V5-6.
What leads are anterior STEMI?
The ECG findings of an acute anterior myocardial infarction wall include: ST segment elevation in the anterior leads (V3 and V4) at the J point and sometimes in the septal or lateral leads, depending on the extent of the MI. This ST segment elevation is concave downward and frequently overwhelms the T wave.
What are the Anteroseptal leads?
Anteroseptal MI on ECG usually is characterized by the presence of ST-elevations in V1-V3 leads acutely followed by the development of Q waves in V1-V3 precordial leads. The presence of Q-waves in these leads is classically referred to as an age-indeterminate anteroseptal infarct.
Which ECG leads are posterior?
Posterior leads Leads V7-9 are placed on the posterior chest wall in the following positions (see diagram below): V7 – Left posterior axillary line, in the same horizontal plane as V6. V8 – Tip of the left scapula, in the same horizontal plane as V6. V9 – Left paraspinal region, in the same horizontal plane as V6.
Are V leads anterior?
Because initial ventricular depolarization is from left to right across the septum, there is an initial R-wave in V1 followed by an S-wave as the anterior and lateral walls of the left ventricle depolarize....Electrocardiogram Chest Leads (Unipolar)LeadsVentricular RegionV5-V6anterolateral2 more rows
How do you know if a STEMI is anterior or posterior?
Look for deep (>2mm) and horizontal ST-segment depression in the anterior leads and large anterior R-waves (bigger than the S-wave in V2). Posterior STEMI often occurs along with an inferior or lateral STEMI, but can also occur in isolation.
What is an anterolateral MI?
Myocardial infarction in which the anterior wall of the heart is involved. Anterior wall myocardial infarction is often caused by occlusion of the left anterior descending coronary artery. It can be categorized as anteroseptal or anterolateral wall myocardial infarction. [
Which leads are inferior MI?
Inferior STEMI is usually caused by occlusion of the right coronary artery, or less commonly the left circumflex artery, causing infarction of the inferior wall of the heart [6, 7]. Upon ECG analysis, inferior STEMI displays ST-elevation in leads II, III, and aVF.
What leads are the Widowmaker?
A widow maker is when you get a big blockage at the beginning of the left main artery or the left anterior descending artery (LAD). They're a major pipeline for blood. If blood gets 100% blocked at that critical location, it may be fatal without emergency care.
What leads are elevated in anterior MI?
The ECG findings of an anterior ST segment elevation myocardial infarction include: ST segment elevation in the anterior leads (V3 and V4) and sometimes in septal and lateral leads, depending on the extent of the infarction.
What ECG leads represents the anterior wall of the heart?
The anterior wall ischaemia/infarction involving the left anterior descending artery (LAD) is usually represented on the ECG with ST-T changes in the precordial leads and in leads I and aVL while those of the inferior wall classically involve leads II, III and aVF.
Which leads on the ECG focus on the anterior aspect of the heart?
Leads V1, V2, V3, and V4 as a group effectively view the anterior portion of the heart and are called the anterior leads. Leads V5 and V6 collectively look at the lateral wall of the left ventricle.
What leads are reciprocal to anterior leads?
The anterior leads V2-3 are reciprocal to posterior leads, so posterior ST elevation and Q waves produce anterior ST depression and tall R waves.
What leads are elevated in anterior MI?
The ECG findings of an anterior ST segment elevation myocardial infarction include: ST segment elevation in the anterior leads (V3 and V4) and sometimes in septal and lateral leads, depending on the extent of the infarction.
What are the positions for a 12 lead ECG?
The first step in acquiring a diagnostic quality 12 lead ECG is the proper positioning of your patient. Ideally, your patient should be in a supine position. However, some patients will not tolerate this. If that's the case, you can put them in a Semi-Fowler's position, partially reclined.
What is the significance of anterolateral ischemia?
Location: Anterolateral is just the description of the location - in front and to the side - where ischemia is seen in a myocardial perfusion scan. The ischemi... Read More
Which type of ischemia suggests that you have more demand for oxgenated blood to the front and side?
See a cardiologist: Anteriorlateral ischemia stronly suggests that you have more demand for oxgenated blood to the front and side of your heart than you coronary arteries ... Read More
What is the lateral limb lead?
Lead aVL, I and –aVR are called lateral limb leads, because they primarily observe the lateral wall of the left ventricle. Note that lead aVR differs from lead –aVR (discussed below). All six limb leads are presented in a coordinate system, which the right hand side of Figure 18 (panel A) shows.
What is the order of the leads in the Cabrera system?
In the Cabrera system, the leads are placed in their anatomical order. The inferior limb leads (II, aVF and III) are juxtaposed, and the same goes for the lateral limb leads and the chest leads. As mentioned earlier, inverting lead aVR into –aVR improves diagnostics additionally.
How does an electrocardiograph generate an ECG lead?
Figure 16. The electrocardiograph generates an ECG lead by comparing the electrical potential difference in two points in space. In the simplest leads these two points are two electrodes (illustrated in this figure). One electrode serves as exploring electrode (positive) and the other as the reference electrode. The electrocardiograph is constructed such that an electrical current traveling towards the exploring electrode yields a positive deflection, and vice versa.
What is Mason Likar's lead system?
Mason-Likar’s lead system simply implies that the limb electrodes have been relocated to the trunk. This is used in all types of ECG monitoring (arrhythmias, ischemia etc). It is also used for exercise stress testing (as it avoids muscle disturbances from the limbs).
What is an ECG lead?
An ECG lead is a graphical description of the electrical activity of the heart and it is created by analysing several electrodes.
Where are the limb leads placed?
Leads I, II, III, aVF, aVL and aVR are all derived using three electrodes, which are placed on the right arm, the left arm and the left leg. Given the electrode placements, in relation to the heart, these leads primarily detect electrical activity in the frontal plane.
Where is the central terminal?
This terminal is a theoretical reference point located approximately in the center of thorax, or more precisely in the centre or Einthoven’s triangle. WCT is computed by connecting all three limb electrodes (via electrical resistance) to one terminal. This terminal will represent the average of the electrical potentials recorded in the limb electrodes. Under ideal circumstances, the sum of these potentials is zero (Kirchoff’s law). WCT serves as the reference point for each of the six electrodes which are placed anteriorly on the chest wall. The chest leads are derived by comparing the electrical potentials in WCT to the potentials recorded by each of the electrodes placed on the chest wall. There are six electrodes on the chest wall and thus six chest leads ( Figure 19 ). Each chest lead offers unique information that cannot be derived mathematically from other leads. Since the exploring electrode and the reference is placed in the horizontal plane, these leads primarily observe vectors moving in that plane.
Accelerated junctional rhythm inferior infarct anterolateral infarct what does this mean?
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Contour abnormality consider anterolateral infarct consistent with inferior infarct probably old what does that mean?
Need moreinformation: Was this a nuclear stress test? infarct means a prior heart attack you mention two different walls of the heart . Tests can have artifacts and can s... Read More
Anterolateral myocardial infarction probably old came up on the ecg. my doctor said its nothing to worry about, can i have an easy to understand defin?
Stupid Computer: The computer reads on ekgs are designed to catch as many heart attacks as possible but they are notorious for overcalling heart attacks. A trained ca... Read More
Ecg reads "cannot rule out previous anterior mi" and " minimal requirements met for current anterior infarct, abnormal comp to previous ecg"?explain?
Clinical correlation: Basically your ECG likely shows low voltage in the anterior precordial leads, which may be secondary to left ventricular hypertrophy, anterior infarct... Read More
Always had abnormal ecg due to inverted twaves last ecg said st & twave abnormality, consider anterior ischemia cant rule out inferior infarct. worry?
Depends: You list "stress echocardiography" - was this normal? It's a much more accurate test than just an ordinary, resting EKG. If your stress echo was norm... Read More
Ecgs during nuke stress test said possible inferior infarct (age unknown).echo b4 test was good. ecgs b4&after good too. docs said im fine.do u agree?
Yes: EKGs are non specific sometimes. We need to look in to nuclear imaging along with clinical evaluation by health care provider. If doc says you are fin... Read More
Had am ekg today read normal sinus rhythm, septal infarct, abnormal ecg. please explain what's wrong with me...?
Not necessarily: A completely normal ekg would have a small r-wave in one lead (v1); if that r-wave were missing, the ekg would be interpreted as suggesting a septal i... Read More
What determines the magnitude of reciprocal change in inferior leads?
NB: The magnitude of reciprocal change in inferior leads is determined by the magnitude of ST elevation in I and aVL (as these leads are electrically opposite III and aVF), and hence may be minimal or absent in anterior STEMIs that do not involve high lateral leads.
Which LAD branch is the site of occlusion?
The site of occlusion can be inferred from the pattern of ST changes in leads corresponding to the two most proximal branches of the LAD: the first septal branch (S1) and the first diagonal branch (D1).
What is anterior inferior STEMI?
Anterior-inferior STEMI due to occlusion of a “wraparound” LAD. This presents with simultaneous ST elevation in the precordial and inferior leads, due to occlusion of a variant (“type III”) LAD that wraps around the cardiac apex to supply both the anterior and inferior walls of the left ventricle
What is the cause of anterior STEMI?
Anterior STEMI usually results from occlusion of the left anterior descending artery (LAD). Anterior myocardial infarction carries the poorest prognosis of all infarct locations, due to the larger area of myocardium infarct size.
How are the different infarct patterns named?
The different infarct patterns are named according to the leads with maximal ST elevation:
Is ST elevation sensitive in AVR?
In the context of anterior STEMI, ST elevation in aVR of any magnitude is 43% sensitive and 95% specific for LAD occlusion proximal to S1. Right bundle branch block in anterior MI is an independent marker of poor prognosis; this is due to the extensive myocardial damage involved rather than the conduction disorder itself.
How many segments are there in an anteroseptal?
The term anteroseptal is based on autopsy data. Multiple attempts have tried to differentiate the myocardial segments based on different imaging modalities. Echocardiogram segments myocardium into 16 segments while single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) uses a 17-segment model. The 17 segment model is based on the long-axis of the heart from base to apex and short-axis through 360 degrees circumferential location dividing a circle into six 60 degrees segments into basal and mid locations, and 90 degrees segment in the apical location, dividing the heart into a total of 17 segments, a model which seems to be in more agreement to the autopsy studies.
What is an anteroseptal myocardial infarction?
Anteroseptal myocardial infarction (ASMI) is a historical nomenclature based on electrocardiographic (EKG) findings. EKG findings of Q waves or ST changes in the precordial leads V1-V2 define the presentation of anteroseptal myocardial infarction. The patients who had an MI with EKG changes in V1-V2 or to V3 or V4, the autopsy report found out that the infarction involved the majority of the basal anterior septum.[1] This nomenclature was in use until recently. Based on more recent studies using echocardiography and cardiac magnetic resonance imaging in the MI patients with ECG changes on V1, V2, there is rarely involvement of the basal anterior septum, but rather apical and anteroapical myocardial segments are most likely involved.[2][3][4][5]
Can anteroseptal infarction cause a ruptured ppillary muscle?
Papillary muscle rupture and free wall rupture are very uncommon with anteroseptal infarction. These complications are more related to the multivessel disease. [10]
Is anteroseptal myocardial infarction a public health problem?
Epidemiology of anteroseptal myocardial infarction as a separate entity has not been the topic of directed studies. In general, MI is one of the major public health problems as the rise in the risk factors for coronary heart disease continues to prevail in society. Studies show that the incidence of NSTEMI is increasing. However, the magnitude and proportion of STEMI and hospital mortality of MI are decreasing. [8]
Which artery supplies the septal branch?
The coronary artery supplying these segments is most commonly the left anterior descending artery and its septal branches, however, anatomical variation is sometimes a possibility. [6]
Can a septum rupture be a complication of anteroseptal MI?
Septal rupture: Apical septum rupture is a rare complication but can occur with anteroseptal MI involving LAD lesion. Prompt diagnosis is necessary, and the treatment of choice is the definitive surgery. [9]
When is reciprocal change only seen in the inferior leads?
NB. Reciprocal change in the inferior leads is only seen when there is ST elevation in leads I and aVL. This reciprocal change may be obliterated when there is concomitant inferior ST elevation (i.e an inferolateral STEMI)
Which branch of the LAD is isolated?
Isolated lateral STEMI is less common, but may be produced by occlusion of smaller branch arteries that supply the lateral wall, e.g. the first diagonal branch (D 1) of the LAD, the obtuse marginal branch (OM) of the LCx, or the ramus intermedius.
What is ST elevation in precordial leads?
ST elevation in the precordial leads plus the high lateral leads (I and aVL) is strongly suggestive of an acute proximal LAD occlusion ( this combination predicts a proximal LAD lesion 87% of the time ).
What is isolated lateral infarction?
Isolated lateral infarction due to occlusion of smaller branch arteries such as the D1, OM or ramus intermedius.
What is lateral STEMI?
Lateral STEMI is a stand-alone indication for emergent reperfusion.
Which arteries supply the lateral wall of the LV?
The lateral wall of the LV is supplied by branches of the left anterior descending (LAD) and left circumflex (LCx) arteries.
Which ventricle is affected by massive infarction?
These changes are consistent with a massive infarction involving the inferior, lateral and posterior walls of the left ventricle.