January 2003
EKG Interpretation
Case #1 reveals an underlying sinus rhythm.
Without knowing patient history or presentation, the ST segment elevations in
leads I, aVL in addition to
ST elevation in V1-V3 indicate an anterior wall myocardial infarction. AMI's
typically involve occlusion or
injury to the left anterior descending artery or its branches. Also of note are
the reciprocal changes in leads
II, III, and aVF which assist the clinician in the preliminary EKG diagnosis.
Case #2 reveals a baseline sinus rhythm. R wave progression in the precordial
leads appears maintained, but
ST segment elevations are observed in leads II, III, and aVF. Reciprocal changes
are present in leads I and aVL.
These EKG changes are consistent with an inferior wall MI. When treating
ischemic pain likely from an inferior
wall infarction, it is advisable to utilize IV fluids. Patients suffering from
this condition who receive nitrates are
at risk for profound hypotension post administration. Inferior wall MI's can
also present with various blocks and
bradydysrhythmias. The right coronary artery and its branches supply many of the
heart's conductive pathways.
Comments? Please email:
Ben Lawner, NREMT-P, MS-II
NSUCOM EMS