Download circumflex artery

Normal ECG
Lead Placement is Important
 Each positive electrode acts as a
camera looking at the heart
 Ten leads attached for twelve
lead diagnostics. The monitor
combines 2 leads.
 Mnemonic for limb leads
 White on right
 Smoke(black) over fire(red)
 Snow(white) on grass(green)
2004 Anna Story
Precordial Leads
2004 Anna Story
4
Rhythm
I and
AVL(LATERAL)
V3 &
v4(ANTERIOR)
V1 &
v2(SEPTAL)
V5 & v6(LATERAL)
II, III and
AVF(INFERIOR)
2004 Anna Story
Where the positive electrode is
positioned, determines what
part of the heart is seen!
7
angina
CORONARY CIRCULATION
The left coronary artery distributes blood to the left side of the
heart, the left atrium and ventricle, and the interventricular
septum
The circumflex artery arises from the left coronary artery
The larger anterior interventricular artery, also known as the left
anterior descending artery (LAD), is the second major branch
arising from the left coronary artery.
The right coronary artery proceeds along the coronary sulcus and
distributes blood to the right atrium, portions of both ventricles,
and the heart conduction system.
marginal arteries arise from the right coronary artery inferior
to the right atrium.
marginal arteries supply blood to the superficial portions of
the right ventricle
On the posterior surface of the heart, the right coronary artery
gives rise to the posterior interventricular artery, also known
as the posterior descending artery.
supply the interventricular septum and portions of both
ventricles.[1]
ECG leads
Location of MI
Coronary Artery
II, III, aVF
Inferior MI
Right Coronary Artery
V1-V4
Anterior or Anteroseptal
MI
Left Anterior Descending
Artery
V5-V6, I,aVL
Lateral MI
Left Circumflex Artery
ST depression in V1, V2
Posterior MI
Left Circumflex Artery or
Right Coronary Artery
acute infero-postero-lateral MI.
Acute Anterior Myocardial
Axis
Left or right axis deviation?
Look at limb leads I and aVF.
Normal: I +, aVF +
LAD: I +, aVF –
RAD: I -, aVF +
HEART AXIS
Many factors may alter the electrical heart axis including:
Anatomic Factors:
Abnormal anatomic position of the heart in the thoracic cavity (such as in
dextrocardia)
Abnormal thoracic anatomy
Abnormal position of the diaphragm (such as in obesity, pregnancy, ascites)
Cardiopulmonary Pathology:
Prior myocardial infarction
Recent ischemia
Pulmonary embolism
Pulmonary obstructive disease
Myocardial hypertrophy
Dilated cardiomyopathy
Conduction abnormalities
Others
Left axis deviation
Right axis deviation
Sinus Bradycardia - SB
Sinus Tachycardia - ST
Sinus Arrhythmia - SA
Irregular irregular
Atrial Fibrillation : A Fib
Atrial Flutter : A Flutter
Junctional rhythms
Premature Ventricular
Contraction: PVC
Ventricular Tachycardia - VT
Ventricular Fibrillation - VF
Asystole
Artifact:
nd
2
Degree AV Block, Type I
(Wenckebach)
2nd Degree AV Heart Block, Type II
rd
3
Degree Heart Block
LBBB
cardioversion
automated external defibrillators or
AEDs.
X-ray on chest showing pacemaker
Left ventricular hypertrophy
Left ventricular hypertrophy (the left ventricle is enlarged
and generates more electrical activity, so the heart axis is
“pulled” to the left)
S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm (≥ 7
large squares)
Left ventricular hypertrophy
Left ventricular hypertrophy