The presence of ST elevationThe upward placement of the ST segment greater than 1 mm from the isoelectric line; suggestive of cardiac infarction or ischemia. Between the QRS complex and the T wave, lies the ST segment. The ST segment usually follows the isoelectric... in most views of a 12 lead ECGElectrocardiogram; also called an EKG; a representation of electrical voltage measured across the chest over a period of time. 1. Six Second ECG Guidebook (2012), T Barill, p. 196 suggests pericarditis.
Pericarditis, an inflammation to the pericardial lining of the heart often attributed to infection, also produces ST elevation on a 12 lead ECG. In fact, because the pericarditis often affects the entire pericardial lining, ST elevation is often seen in most every lead of a 12 lead ECG. The treatment for pericarditis is very different than the treatment for a myocardial infarctionThe necrosis or death of myocardial tissue due to insufficient supply of oxygen to the infarcted region. The ability to identify cardiac ischemia, injury and infarction is vital in the management of the majority of cardiac emergencies. Most sudden cardiac.... Mixing the two could have grave consequences. The presence of global ST changes (most leads) in a 12 lead should prompt a more complete history and physical assessment.
Ventricular rhythms and supraventricularLocated above the ventricle – includes the bundle of His, AV node, atria and the SA node. 1. Six Second ECG Guidebook (2012), T Barill, p. 206 rhythms with left bundle branch blockA bundle branch block must satisfy two criteria - a wide QRS complex and a notch in the QRS complex. To distinguish between a RBBB and a LBBB, first make certain that the rhythm is indeed supraventricular (P waves before... have wide and bizarre QRSThe electrical representation of ventricular depolarization; the atrial repolarization is also a part of the QRS. ECG interpretation relies heavily on the QRS complex. The QRS complex represents the depolarization of the ventricles. The repolarization of the atria is also... complexes, making the detection of ST changes all but impossible.
Several conditions not linked to cardiac ischemiaThe ability to identify cardiac ischemia, injury and infarction is vital in the management of the majority of cardiac emergencies. Most sudden cardiac deaths are associated with an ischemic episode. Patient deaths due to an acute myocardial infarction (MI) typically... can produce ST changes. The bottom line: most ST changes indicate cardiac ischemiaInsufficient supply of oxygen to meet the oxygen demands of tissue. Anaerobic metabolism becomes increasingly important during periods of ischemia. Ischemia results from an inadequate blood flow that fails to meet the oxygen demands (energy demands) of tissues. If tissues..., requiring urgent treatment BUT every ECG interpretation is more robust when integrated with a patient’s clinical status and history.
The presence of ST elevation in most leads can point to the presence of pericarditis – not myocardial infarctionThe necrosis of tissue; acute myocardial infarction involves the acute death of myocardial cells. 1. Six Second ECG Guidebook (2012), T Barill, p. 198. Administering fibrinolytics to a patient experiencing pericarditis can have disastrous effects. It is prudent to examine all the leads to rule out this possibility. Of course, examining all the leads (with the exception of aVR) will often yield a more comprehensive electrical picture.
1. Six Second ECG GuidebookA Practice Guide to Basic and 12 Lead ECG Interpretation, written by Tracy Barill, 2012 Introduction The ability to correctly interpret an electrocardiogram (ECG), be it a simple six second strip or a 12 lead ECG, is a vital skill... (2012), T Barill, p. 88, 147, 150