STEMI EKG Changes

Question 1

Vessel and wall involved with ST elevation in
II, III, aVF

Answer 1

RCA inferior LV (Reciprocal I, aVL)

Question 2

Vessel and wall involved with ST elevation in
V1, V2, V3, V4

Answer 2

LAD, anterior LV (Reciprocal ST dep. II, III, AVF )

Question 3

Vessel and wall involved with ST elevation in V5,V6,I,aVL

Answer 3

Circumflex, anterior LV

Question 4

Vessel and wall involved with ST elevation in V5, V6

Answer 4

Left Circumflex low lateral wall LV

Question 5

Vessel and wall involved with ST elevation in I, aVL

Answer 5

high lateral LV wll

Left Circumflex vessel

Question 6

Vessel and wall involved with ST elevation in V1, V2

Answer 6

Anteroseptal

LAD occlusion

Question 7

Vessel and wall involved with ST elevation in V3R, V4R

Answer 7

RCA, RV infarct

Question 8

Inferior MI lead changes
vessel location and effects

Answer 8

ST elevation in II, III, aVF

vessel is RCA 80% of the tie and LCX 18% of the time

Reciprical in I, aVL

Associated with AV conduction disturbances like 2nd degree Type I
3rd degree AVB, Sick sinus syndrome, sinus brady
mitral valve regurgitation 2nd to papillary muscle rupture, RCA is the only source of posterior papillary muscle )

Question 9

RV Infarct lead changes, vessel location and effects?

Answer 9

v1 and “R” leads

RCA occlusion
JVD at 45 degrees
High CVP
hypotension
clear lungs
bradyarrhthmias
RISKS: hypotension–avoid nitro, BB

Question 10

Anterior MI lead changes vessel location and effects?

Answer 10

LAD occlusion
ST elevation in V1-V4 reciprocal changes in II, III, aVF
2nd degree Type II AVB or RBBB as LAD supplies bundle of His (ominous sign)
systolic murmur, possible VSD
higher mortality than inferior MI

Question 11

RVMI Triad

Answer 11

JVD –r/t poor RV pumping backing up blood to body, SVC> Jugular vein
Clear Lungs – RA & LV able to pump effectively not backing up in lungs
Hypotension – RV pump failure decreasing LV preload lowering BP