anesthesiaekg4 (EKG changes with MI ** )

EKG, changes seen with MI

• Lead I  — negative at right shoulder and positive at left shoulder
• Lead II — negative at right shoulder and positive at apex of heart
• Lead III — negative at left shoulder and positive at apex of heart
• Lead V1 — 4th right intercostal space
• Upward deflection moving toward positive aspect of lead
• Three I’s
  1. Ischemia — ST depression, T inversion
  2. Injury — ST elevation
  3. Infarction — Q waves (1/3 the size of R and greater than 1 box [0.04])
• Non-Q MI (nontransmural) involves distal CA’s and shows ST depression
• Inferior MI — 2, 3, F
• Anterior MI — V2, V3, V4
• Septal MI — V1, V2
• Lateral MI — V5, V6
• High lateral MI — 1, L
• Posterior MI — reciprocal changes in anterior leads (V1 to V3)
• Q alone — old MI 
• Q with ST elevation — currently occurring
• Flipped T waves in V leads are significant
• With LBBB, you get ST depression in lateral leads, hard to read changes
• Injury (ST elevation) can also be caused by pericarditis or aneurysm

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