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Anterior MI: Difference between revisions
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Proximal or distal occlusion of the LAD can be differentiated when looking at the ST elevation V1-V3 <cite>Zimetbaum</cite> | Proximal or distal occlusion of the LAD can be differentiated when looking at the ST elevation V1-V3 <cite>Zimetbaum</cite> | ||
;Characteristics of proximal LAD occlusion | ;Characteristics of proximal LAD occlusion | ||
*ST-segment elevation in V1 (>2.5 mm) or [[RBBB]] with a pathologic [[Pathologic Q Waves|Q wave]] or both | *ST-segment elevation in V1 (>2.5 mm) or [[RBBB]] with a pathologic [[Pathologic Q Waves|Q wave]] or both (sens 12%, spec 100%) | ||
*ST-segment depression (>1 mm) in II, III and aVF | *ST-segment depression (>1 mm) in II, III and aVF (sens 34%, spec 98%) | ||
;Characteristics of distal LAD occlusion | ;Characteristics of distal LAD occlusion | ||
*Little ST-segment depression (<= 1 mm) or even elevation in II, III, and aVF | *Little ST-segment depression (<= 1 mm) or even elevation in II, III, and aVF (sens 66%, spec 73%) | ||
Another way to look at this is by assessing the axix of the ST vector. If it points upwards (with ST depression in II, III, and AVF) the proximal LAD is occluded. If it points downwards (with little ST depression or even elevation in II, III, and AVF) the distal LAD is occluded. An ECG that does not show any ST depression sugggests an occlusion after the origin of the first diagonal branch. | Another way to look at this is by assessing the axix of the ST vector. If it points upwards (with ST depression in II, III, and AVF) the proximal LAD is occluded. If it points downwards (with little ST depression or even elevation in II, III, and AVF) the distal LAD is occluded. An ECG that does not show any ST depression sugggests an occlusion after the origin of the first diagonal branch. | ||