✓ ST segment is slightly elevated normal in V 1 ( 1 small square )
🛑How to recognise ST segment elevation ?
👀 look at J point and compare it with isoelectric line , if J point is elevated above it , there is ST segment elevation !!
🔷 Note any detected ST segment elevation in all leads
🔷 If the patient has acute chest pain suspicious to be ischemic !!
Look for ST elevation in contiguous leads
المتجاوره ومن نفس المجموعه زي ال ⤵️⤵️⤵️
🚩Lead II , III & aVF --> inferior leads
🚩Lead I , aVL , V5 & V6 --> lateral leads
🚩Lead V1 - V4 --> anteroseptal leads
⤵️ بنشوف كم
Lead has ST segment elevation!!
✔️look also for pathological Q in the same leads with STE
So for conclusion ⤵⤵⤵
🛑ST segment elevation ➕ pathological Q in II , III and aVF --> inferior STEMI
🛑ST segment elevation ➕ pathological
Q in I, aVL--> high lateral STEMI
🛑ST segment elevation ± pathological Q in
V5 & 6 --> lateral STEMI
🛑ST segment elevation ± pathological Q in V1 - 4 --> anteroseptal MI
🛑 ST segment elevation ± pathological Q in V1 - V6 --> extensive anterolateral STEMI
🔎 Search for reciprocal changes
⬇️⬇️⬇️
Associated ST depression ± T wave inversions in other groups
مثــال
#Inferior STEMI ---> reciprocal changes in lateral ( aVL ± I)
#Lateral & Anterolateral STEMI --> reciprocal changes in inferior leads
🔎 ملحوظه هاامه جداا
# any patient C/O ischemic chest pain with positive R in V1 - V3 with horizontal depression and upright T wave --> posterior MI
Posterior MI often co-exists with inferior STEMI
#if the patient has chest pain (pleuritic in nature ) , ↓ on leaning forward and ↑ on recumbency plus such picture in ECG
⬇️⬇️⬇️⬇️⬇️
Diffuse STE with upward concavity + depressed P R segment ---> Pericarditis
#if patient has wide spread ST segment elevation with fish hook apprearence at the end of S wave ده حاجه اسمها ⤵️⤵️⤵️⤵️⤵️⤵️
Being early repolarization ( high take off)
🛑How to recognise S T depression ?
J point is depressed in comparison to isoelectric line
#if the patient has ischemic chest pain ⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️
And his ECG showing
ST depression ± T wave inversion
غالبا ده ischemia !!!
___
9️⃣T wave
👉Normally , it is upright in leads ,but it might be inverted normally in aVR , III and V1
👉T wave often follows the preceding QRS
✨ Amplitude
The amplitude of T wave shouldn't exceed 2 large squares in chest leads & 1 large square in limb leads
🌴اذا زاد عن كذه يبقى ⤵️⤵️⤵️
Either Tall peaked Or Hyperacute
#Tall peaked ( tented)
indicatea hyperkalemia ...
#hyperacute T wave then ST segment elevation appears ± pathological Q = STEMI ....
#flat T waves : if all T waves are flat ± u wave after it ---> hypokalemia
#Inverted T waves : has many causes , but the most important cause is ischemia
Inverted T waves of often regional in ischemia ⤵️⤵️⤵️⤵️⤵️
Inferior , Lateral , anterolateral
🌴ملحوظه هااامه 🌴
#Both LVH and RVH are often associated with inverted T waves ± abnormal ST segment --> Strain pattern
#LVH --> inverted T in lateral leads V5&V6
#RVH --> inverted T in V1 & V2
#Both LBBB and RBBB often have associated T wave inversions + abnormal ST segment
#LBBB -->inverted T in V6 + broad R pattern ( m)
#RBBB --> inverted T in V1+ M pattern ( RSR')
1️⃣0️⃣)Q T interval
===============
Interval starting from the beginning of Q to the end of T wave !!
Normally it is up to 440 m.sec in males
مربعين كبار ومربع صغير
Up to 420 m.sec in females
#if > 440 m.sec in ♂️ and > 420 m.sec in ♀️ ➡️ Long QT interval مهم
Long QT syndrome has a risk for sudden occurence of Polymorphic Ventricular Tachycardia ( torsade de pointes ) if QTc > 500 m.sec مربعين ونص كبار تقريبا ....
