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Ischemia, Injury Infarction ECG Interpretation


Part 1

Think of the process of ischemia, injury and infarction as a worsening continuum.

If immediate, aggressive and effective care is not provided, ischemia will worsen (or progress) to injury and ultimately infarction (tissue death)

Ischemia, injury and infarction each impact the cardiac complex in unique ways.

Part 2

12-Lead Analysis requires we follow these steps of analysis.

  • ST segment for presence of deviation
  • T wave morphology changes
  • Q wave morphology changes

Part 3

The changes I have been referring to must occur in anatomically contiguous leads. This refers to 2 or more leads “looking” at (viewing) the same part of the heart or numerically consecutive chest leads

Examples Include:

  • II, III, aVF (2 of the 3 leads must show changes. It does not have to be all three)
  • I, aVL can show changes and not effect V5 and V6 to still be clinically significant
  • Numerically consecutive chest leads

We always recall that V1 is next to V2, but do not forget that V2 is also contiguous with (next to) V3…if V2 & V3 are showing changes, this is clinically significant too. See the next slide for an illustration.




Authors and Sources

Authors and Reviewers


Sources

  • Electrocardiography for Healthcare Professionals, 6th Edition Kathryn Booth and Thomas O'Brien
    ISBN10: 1265013470, ISBN13: 9781265013479
    McGraw Hill, 2023
  • Rapid Interpretation of EKG's, Sixth Edition
    Dale Dublin
    Cover Publishing Company
  • EKG Reference Guide
    EKG.Academy
  • 12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
    Aaron Reed
    Create Space Independent Publishing
  • Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
    Elsevier-Health Sciences Division
    Barbara A. Erickson, PhD, RN, CCRN
  • The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
    Publisher: Lippincott Williams & Wilkin)
    ISBN-10: 0781784425; ISBN-13: 978-0781784429
  • Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
  • ECG Reference Guide
    PracticalClinicalSkills.com






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