00:01
Now, localizing AMI by EKG.
00:04
If it is ST elevation,
what are we going to do?
We are going to localize and
we will take a look at next
and I have referred
to this already.
00:10
Now, as I said,
we are going to repeat.
00:13
In a couple of
lecture series ago,
I talked to you about blood vessels
and their respective EKG leads, right?
So now we are going to
take a look at the table
and we are going to
harp on that very fact.
00:26
ST depression,
what does that mean?
It doesn't localize, but what you
call an ST depression type of MI?
You call that a
non-STEMI, is that clear?
It is not an ST elevation,
it is an ST depression.
00:37
So how can you tell the difference? May I
ask you this question so that you clear?
How can you tell the difference
between, an ST depression that you found
with stable angina upon
administering a stress test
versus an ST depression that you might
find with the myocardial infarction?
You answer that
question, please.
00:55
Cardiac enzymes, good.
00:57
Cardiac enzymes,
are they ever found in angina?
Never. Clear? Is that clear?
And it should be.
01:04
Cardiac enzymes will not be
found in stable, unstable angina.
01:09
Now here we go,
I told you earlier that we are going to walk
through the different coronary arteries
and its respective ST
elevations, Arteries.
01:19
I very much wish to bring to your
attention that I did not say arteriole.
01:24
So let us take a look at left anterior
descending, which is the artery
and where exactly on
the heart is the supply.
01:29
Take a look,
Anteroseptal towards the apex, okay.
01:33
So, I want you to go in that
order of your precordial leads.
01:37
Begin it at V1 because that is
your interventricular septum,
anti 2/3 of your interventricular
septum is your LAD,
used to be called and still
is the widow maker, right.
01:47
Massive MI and you will find an ST
elevation, at least, V1 through V4.
01:53
V6, I'm going to leave that out.
V5, that's more lateral,
but at least know V1 through V4.
01:59
Lateral walls.
02:01
Well, with lateral walls, we have left
anterior descending and left circumflex.
02:07
With that said,
let us take a look at ST elevation here.
02:10
If you focus on leads V1, V2, and V3 approximately
in the middle of that stage of ECG,
you will notice that this
would be an ST elevation.
02:19
You see that crazy convex
type of ST elevation.
02:24
Huge, massive,
specifically in those precordial leads,
which coronary
artery would this be?
Left anterior descending,
is that clear?
V1 through V4 you see something
like this and please know,
I don't care which licensing
exam that you are taking.
02:42
All 12 leads will be given to you
and when they are given to you,
it is imperative that you know
how to interpret and do not panic.
02:49
Once you panic,
this whole thing looks like a blur.
02:51
You focus here V2, V3, V4.
02:55
What are you looking at there?
An ST elevation.
02:57
And those ST elevations
to you should indicate
left the anterior
descending type of issues.
03:04
Okay now, what if it is the lateral wall?
Then it is the left circumflex also.
03:09
And this would be your
V5, V6, that is official.
03:12
And we have a lead I and
aVL, absolutely lateral.
03:16
Left circumflex should
be your focus here.
03:18
Left anterior descending could be
involved, but your focus, left circumflex.
03:22
What about the inferior wall?
This would be your right coronary artery.
03:26
So, therefore, your leads here would be II
at approximately 60 degrees, and from physio
and from your medical
education, you know lead II
is probably the most important lead in terms
of proper depolarization of your heart
from the base towards the apex.
Is it not? Of course, it is.
03:45
So lead II becomes a very important
lead to you at every possible respect.
03:50
In addition to that,
we have V3 and aVF, augmented foot.
03:55
And that would be the
inferior portion of the heart.
03:58
And you if find an ST
elevation in those leads,
then you are thinking about which coronary
artery? RCA. Right coronary artery.
04:07
Now here, what we are
looking at is exactly that.
04:10
Take a look at lead II at the second
to the bottom, you have lead II.
04:15
You have an ST elevation and for the
most part, you see something like that.
04:18
Then you should be thinking, well is my
patient having an inferior type of MI?
And if you take a look at the aVF,
you will notice there as well,
you call it a fireman's hat.
04:32
If you actually take a
look at that ST elevation
and the QRS complex
and collectively
and clinically speaking, or you know
just to perhaps for amusement sake,
it is the fact that looks like
a hat that a fireman might wear.
04:46
So ST elevations II, III, aVF.
04:50
What coronary artery, please?
Right coronary artery.