ECG: Myocardial Infarction with CHB
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Transcript of ECG: Myocardial Infarction with CHB
-Prof .Dr.Gowrishankar’s Unit
-Dr.A.Ishwarya
45 year old male patient was brought to ICCU with
C/OCHEST PAIN * 2 HOURS
K/C/O T2DM/SHT
VITAL SIGNS • PR-54/Min• BP-90/74 mm hg• JVP RAISED
O/E CVS: S1S2+
NO MURMUR RS: B/L CREPS+ CNS:NFND P/A:SOFT
Rate of P wave 80/minRate of QRS complex 60/minNot in sinus rhythmDuration of QRS <0.12 secP wave inverted in lead II, avf/ upright in aVr Varying PR intervalPP interval constant (0.8 sec)RR interval constant (1.12 sec)ST elevation in lead II ,III ,aVf/ ST elevation in V3R-
V5R,V7-V9ST depression in lead I , aVLR>S in Lead V2 & S > R in Lead aVLST depression in V2-V4 (mirrror changes of
posterior MI)
Bradyarrhythmia-Type Incidence
Sinus Bradycardia 25%
Junctional Escape Rhythm 20%
Idioventricular escape rhythm
15%
I Degree AV Block 15%
II Degree AV Block –Type 1 12%
II Degree AV Block –Type 2 4%
Complete Heart block 15%
RBBB 7%
LBBB 5%
LAFB 8%
LPFB 0.5%
Hyper vagotonia Ischemia of AV node
Site of block Intranodal Infranodal
Site of infarction Inferoposterior Anteroseptal
Compromised arterial supply
RCA (90%), LCX (10%) Septal perforators of LAD
Pathogenesis Ischemia, excess parasympathetic activity
Ischemia, necrosis, hydropic cell swelling
Predominant type of AV nodal block
First-degree (PR > 200 msec)
Mobitz type I second-degree
Mobitz type II second-degree
Third-degree
Location Proximal conduction system (His bundle)
Distal conduction system (bundle branches)
QRS width <0.12/sec[*] >0.12/sec
Rate 45-60/min but may be as low as 30/min
Often <30/min
Stability of escape rhythm
Rate usually stable; asystole uncommon
Rate often unstable with moderate to high risk of ventricular asystole
Duration of high-grade AV block
Usually transient (2-3 days)
Usually transient but some form of AV conduction disturbance and/or intraventricular defect may persist
Associated mortality rate
Low unless associated with hypotension and/or congestive heart failure
High because of extensive infarction associated with power failure or ventricular arrhythmias