hasbutton.blogg.se - Reciprocal changes ekg

PAILS stands for P-posterior A-anterior I-inferior L-lateral S-septal.

Remember the PAILS mnemonic when assessing for reciprocal changes.

ST elevation greater than 1 mm in 2 contiguous leads (2 mm in V2 and V3) should make you seriously entertain the diagnosis of STEMI in your patient and prompt immediate action to activate the nearest cardiac cath lab.

Seeing this ECG should obligate an immediate consultation to the cardiology service and to the cardiac cath lab for possible stenting. ST depression in aVL (a lateral lead) is likely a reciprocal change from inferior ST elevations discussed above. This is especially concerning in the presence of upright T waves in these leads. The ST depressions in the anterior leads of this ECG should make you concerned for a posterior wall MI and should prompt a posterior ECG. ST elevation is considered significant if there is at least 1 mm (one small box) of elevation at the J point in at least 2 contiguous leads except for the precordial leads (V2, V3) which require 2 mm of elevation to be significant.

They are also at risk of developing bradycardia secondary to AV block. These patients should not be given nitroglycerin as it may instigate hypotension. ST elevations in the inferior leads are concerning for inferior wall MI which usually occurs from RCA occlusion. Significantly, there are ST elevations in the inferior leads (II, III, aVF) as well as ST depressions in aVL, V1, V2, V3. The QRS complex is narrow and there are no delta waves in any lead. The PR interval is on the high end of normal, and the QTc is normal. As always we will approach this ECG in a systematic way to ensure the obvious findings don't obscure subtler findings.įirst of all, this ECG demonstrates sinus rhythm with regular rate and normal axis. This ECG is clearly concerning for an ischemic event, with both ST elevations and ST depressions. A 59-year-old male smoker with a history of hypertension, familial hyperlipidemia and insulin dependent diabetes presents with 2 hours of substernal chest pressure radiating to his right arm.