Ischemia, Injury Infarction ECG Interpretation
Think of the process of ischemia, injury and infarction as a worsening continuum.
If immediate, aggressive and effective care is not provided, ischemia will worsen (or progress) to injury and ultimately infarction (tissue death)
Ischemia, injury and infarction each impact the cardiac complex in unique ways.
12-Lead Analysis requires we follow these steps of analysis.
- ST segment for presence of deviation
- T wave morphology changes
- Q wave morphology changes
The changes I have been referring to must occur in anatomically contiguous leads. This refers to 2 or more leads “looking” at (viewing) the same part of the heart or numerically consecutive chest leads
- II, III, aVF (2 of the 3 leads must show changes. It does not have to be all three)
- I, aVL can show changes and not effect V5 and V6 to still be clinically significant
- Numerically consecutive chest leads
We always recall that V1 is next to V2, but do not forget that V2 is also contiguous with (next to) V3…if V2 & V3 are showing changes, this is clinically significant too. See the next slide for an illustration.
Authors and Sources
Authors and Reviewers
- ECG heart rhythm modules: Thomas O'Brien.
- ECG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
- Spanish language ECG: Breena R. Taira, MD, MPH
- Medical review: Dr. Jonathan Keroes, MD
- Medical review: Dr. Pedro Azevedo, MD, Cardiology
- Last Update: 11/8/2021
Electrocardiography for Healthcare Professionals, 5th Edition
Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Cover Publishing Company
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG
Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
- Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH