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| == T Wave ==
| | #REDIRECT[[ECG (main)]] |
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| *Distribution
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| **T wave is normally inverted in aVR; sometimes inverted in III, aVF, aVL, V1
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| *T-wave inversions in V2-V6 are always pathologic
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| *Morphology
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| **Inverted, symmetric,
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| **Transient changes suggests ischemia without infarction
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| **Persistent changes suggests infarction (troponin elevation usually seen)
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| *Pseudonormalization
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| **In presence of baseline TWI (within 1 month), reocclusion causes normalization of TWI
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| **Should be interpreted as evidence of ischemia
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| == [[Q wave]] ==
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| == ST Segment Depression ==
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| *DDx: Post. STEMI, Subendocardial Infarct, Ischemia, Reciporical Changes, Strain c LVH, Dig effect
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| *Contour: Most-->Least concerning for ischemia: Planar/Flat (90%) --> Concave up (33%) --> Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern)
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| *Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise
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| *Indicators of ischemia:
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| **>0.5mm depression from baseline (especially >1mm) in two or more contiguous leads
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| **Transient depression
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| **Morphology that is flat or downsloping
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| *Strain: <br>
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| **tall R wave
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| **only in lateral leads (not anterior)
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| **"checkbox" or asymmetric TWI
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| **down sloping pattern
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| == ST Segment Elevation ==
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| *Stage 1
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| **Timing: 30min - hours
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| **Finding: hyperacute T waves
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| ***>6mm limb leads
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| ***>10mm precordial leads
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| **Duration: normalizes in days, weeks, or months
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| *Stage 2
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| **Timing: minutes - hours
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| **Finding: ST segment elevation
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| ***≥0.1mV in two or more contiguous leads
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| **Duration: ST segment resolution occurs over 72hrs; completely resolves w/in 2-3wks
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| *Stage 3
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| **Timing: within 1hr; completed within 8-12hr
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| **Finding: Q waves
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| **Duration: persist indefinitely in 70% of cases
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| [[Image:STEMI Progression.jpg]]
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| *a: 30min after chest pain onset
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| *b: 45min after chest pain onset (hyperacute T waves)
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| *c: 70min after chest pain onset (ST elevation)
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| *d: 3hr after PCI (ST segment has decreased, TWI incdicates reperfusion)
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| *e: 5 days after PCI (ST segment back to baseline, TWI is near baseline)
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| == Reciprocal Changes ==
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| #Anterior STEMI | |
| #*Reciprocal ST-segment depression in at least one of leads II, III, aVF
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| #*Occurs in 40-70% of cases
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| #Inferior STEMI
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| #*Reciprocal ST-segment depression usually present in I, aVL; often in V1-V3
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| #*Occurs in 56% of cases
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| #Posterior STEMI
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| #*Reciprocal ST-segment depression in V1-V4
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| #**Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI
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| #*Often associated w/ ST-segment elevation in II, III, aVF (inferior involvement)
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| == See Also ==
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| *[[ACS - Anatomical Correlation]]
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| *[[ACS - Risk Stratification]]
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| *[[ECG (Main)]]
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| == Source ==
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| *Electrocardiography in Emergency Medicine. ACEP Textbook.
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| [[Category:Cards]]
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