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Myocardial Infarction: Difference between revisions
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→The location of the infarct
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The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG). On the CAG report, the place of the occlusion is often graded with a number (for example LAD(7)) using the classification of the American Heart Association.<cite>AHACAG</cite> | The localisation of the occlusion can be adequately visualized using a coronary angiogram (CAG). On the CAG report, the place of the occlusion is often graded with a number (for example LAD(7)) using the classification of the American Heart Association.<cite>AHACAG</cite> | ||
==Development of the ECG during persistent ischemia== | |||
[[Image:AMI_evolutie.png|thumb| The evolution of an infarct on the ECG. ST elevation, Q wave formation, T wave inversion, normalisation with a persistent Q wave]] | |||
[[Image:PathoQ.png|thumb| A [[pathological Q wave|pathological Q wave]]]] | |||
The cardiomyocytes in the ''subendocardial'' layers are especcially vulnerable for a decreased perfusion. Subendocardial ischemia manifests as ST depression and is usually reversible. In a myocardial infarction ''transmural ischemia'' develops. | |||
In the first hours and days after the onset of a myocardial infarction, several changes can be observed on the ECG. First, '''large peaked T waves''' (or ''hyperacute'' T waves), then '''ST elevation''', then'''negative T waves''' and finally '''[[pathological Q waves]]''' develop. | |||
{| class="wikitable" | |||
|- | |||
|+'''Evolution of the ECG during a myocardial infarct''' | |||
|- | |||
! | |||
!see figure | |||
!change | |||
|- | |||
!minutes | |||
| not in figure | |||
b | |||
| hyperacute T waves (peaked T waves) | |||
ST-elevation | |||
|- | |||
!hours | |||
| c | |||
d | |||
| ST-elevation, with terminal negative T wave | |||
negative T wave (these can last for months) | |||
|- | |||
!days | |||
| e | |||
| [[pathological Q waves]] | |||
|- | |||
|} | |||
{{clr}} | |||
==References== | ==References== | ||