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ECG - Ischaemic Heart Disease

  • 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
  • Widespread ST depression
  • ST-T changes
  • No changes
  • 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)

ECG References

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