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ECG - Ischaemic Heart Disease

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STEMI

1st Hyperacute T waves
2nd ST elevation with reciprocal ST depression
3rd T wave inversion
4th Loss of R wave height
5th Q waves develop: these signify transmural infarction which acts as an electrical window allowing the depolarisation of the opposite myocardium

NSTEMI

Widespread ST depression
ST-T changes
No changes

Ischaemia

ST depression
T wave changes
Deep Inverted T waves - can often indicate severe coronary artery disease in that territory e.g. Deep anterior T wave inversion - LAD stenosis and Deep inferior T wave inversion - suggests RCA stenosis

Correlating ECG and Culprit vessel- there is much variation.

Arterial occlusion ECG leads affected with ST elevation, T wave inversion, Q waves

Left anterior descending V1-V4

Circumflex V1 - reciprocal e.g. tall R wave instead of Q waves and ST depression rather than elevation (True posterior)

Right coronary artery ST elevation, T wave changes, Q waves in II, III, aVF (inferior)

Distal RCA/Side branch of Cx Lateral V5/6 changes (lateral)

Proximal LAD V1-6, I, aVL anterolateral

Proximal RCA II,III,avF, V5,V6 inferolateral

Proximal RCA/CX II,III,aVF dominant R wave in V1 (inferoposterior)

Proximal RCA/CX II,III,aVF dominant R wave in V1, V5,V6 (inferoposteriolateral)

Arterial occlusion	ECG leads affected with ST elevation, T wave inversion, Q waves
Left anterior descending	V1-V4
Circumflex	V1 - reciprocal e.g. tall R wave instead of Q waves and ST depression rather than elevation (True posterior)
Right coronary artery	ST elevation, T wave changes, Q waves in II, III, aVF (inferior)
Distal RCA/Side branch of Cx	Lateral V5/6 changes (lateral)
Proximal LAD	V1-6, I, aVL anterolateral
Proximal RCA	II,III,avF, V5,V6 inferolateral
Proximal RCA/CX	II,III,aVF dominant R wave in V1 (inferoposterior)
Proximal RCA/CX	II,III,aVF dominant R wave in V1, V5,V6 (inferoposteriolateral)

ECG References

See Excellent EKG resource

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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