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Acute ST-segment-elevation anterolateral myocardial infarction

When an acute coronary syndrome is suspected, the first priority is to look for ST segment elevation. This usually implies complete occlusion of a coronary artery and the need to make immediate arrangements for reperfusion therapy. Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 1 –Red arrows

There is ST segment elevation in the anterior chest leads and in the lateral leads, so this is an anterolateral ST elevation MI and immediate reperfusion therapy should be considered.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 2 – blue arrows

Note also that there are Q waves in the anterior leads. When an area of myocardium is damaged to the point where it becomes electrically inactive the overlying ECG leads show the development of Q waves. These can appear very early in the course of infarction, but may develop later due to progressive damage. Early intervention to re-open a blocked coronary artery may limit the amount of myocardial damage and reduce or prevent the development of Q waves.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 2 – blue arrows

Note also that there are Q waves in the anterior leads. When an area of myocardium is damaged to the point where it becomes electrically inactive the overlying ECG leads show the development of Q waves. These can appear very early in the course of infarction, but may develop later due to progressive damage. Early intervention to re-open a blocked coronary artery may limit the amount of myocardial damage and reduce or prevent the development of Q waves.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 2 – blue arrows

Note also that there are Q waves in the anterior leads. When an area of myocardium is damaged to the point where it becomes electrically inactive the overlying ECG leads show the development of Q waves. These can appear very early in the course of infarction, but may develop later due to progressive damage. Early intervention to re-open a blocked coronary artery may limit the amount of myocardial damage and reduce or prevent the development of Q waves.

Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 3 – yellow arrows
ST segment depression is present in leads III and aVF, in the presence of marked anterior ST segment elevation. In this setting, this appearance in these inferior leads often represents reciprocal ST depression, reflecting ST segment elevation arising in the opposite wall of the left ventricle, rather than a problem in the inferior wall itself.
Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
Hotspot 3 – yellow arrows
ST segment depression is present in leads III and aVF, in the presence of marked anterior ST segment elevation. In this setting, this appearance in these inferior leads often represents reciprocal ST depression, reflecting ST segment elevation arising in the opposite wall of the left ventricle, rather than a problem in the inferior wall itself.
Look at this ECG from a patient with severe chest pain. Click on the coloured arrows to find out more. Select Next to continue.
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Essentials
Algorithm
References

References

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See chapter 4 of the ALS manual for further detail relating to the assessment and treatment of Acute Coronary Syndromes.

Acute coronary syndromes: immediate treatment and
components of a normal ECG rhythm strip

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Acute coronary syndromes: immediate treatment

Give immediate treatment to relieve symptoms, limits myocardial damage and reduce the risk of cardiac arrest. Immediate general treatment for ACS comprises:

  • Aspirin
  • Nitroglycerine
  • Oxygen
  • Morphine or Diamorphine

Components of a normal ECG complex

  • Depolarisation begins in the SA node and then spreads through the atrial myocardium
  • This depolarisation is recorded on the rhythm strip as the P wave. The heart responds to this electrical stimulus byatrial contraction
  • The small isoelectric segment between the P wave and QRS complex represents the delay in transmission through the AV node
  • Depolarisation of the bundle of His, bundle branches and ventricular myocardium is shown on the rhythm strip as the QRS complex
  • The T wave represents recovery of the resting potential (repolarisation) in the cells of the conducting system and ventricular myocardium

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<p>Components of a normal ECG – close up of QRS complex.</p><p></p>

The ABCDE approach and access to reperfusion therapy for STEMI

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All patients with a suspected acute coronary syndrome should be assessed using the ABCDE approach.

The ABCDE approach stands for:

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure

In addition where an ST-elevation MI is evident immediate reperfusion therapy should be arranged unless contra-indicated.

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Access to reperfusion therapy for STEMI algorithm.

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