Coronary ischemia ecg

Key Points for Practice • Attempt to perform 12-lead ECG in patients with chest pain within 10 minutes of arrival to a clinic or emergency setting. • Use a clinical decision pathway to identify patients with low-risk chest pain who can be discharged from the emergency department. • If available, use CCTA preferentially over stress testing for patients with intermediate-risk chest pain to determine the need for invasive coronary angiography. For patients with high-risk chest pain, provide referral for invasive coronary angiography. • In patients with known CAD, focus on controlling blood pressure and cholesterol. Consider CCTA to document CAD progression in patients with previous testing demonstrating nonobstructive lesions. From the AFP Editors Chest pain leads to about 4 million outpatient visits per year and is the second most common reason for emergency department care, with nearly 7 million visits per year. Although most chest pain is noncardiac, more than 18 million people in the United States have coronary artery disease (CAD), leading to more than 1,000 deaths per day. The American Heart Association/American College of Cardiology (AHA/ACC) updated guidelines for management of chest pain, which are endorsed by five other cardiology groups. The guidelines provide new recommendations on what to consider chest pain and when to avoid testing in patients at low risk, and they endorse use of published decision pathways to determine the order and extent of workup. Chest pai...

• Basic anatomy & physiology • Introduction to ECG Interpretation • Arrhythmias and arrhythmology • Myocardial Ischemia & Infarction • Conduction Defects • Cardiac Hypertrophy & Enlargement • Drugs & Electrolyte Imbalance • Genetics, Syndromes & Miscellaneous • Exercise Stress Testing (Exercise ECG) • Pacemaker & CRT • Pediatric & neonatal ECG • ECHO • TAKE A TEST • POPULAR ECG in acute myocardial ischemia: ischemic ST segment & T-wave changes This chapter discusses typical and atypical changes in the ST segment and the T-wave during ST segment deviations ( T-wave changes. The reader may wish to view our video lecture on The normal ST segment and T-wave The ST segment The ST segment represents the plateau phase (phase 2) of the Figure 1 A). The plateau phase has a long duration which enables the majority of the ventricular myocardium to contract simultaneously. Sincethe membrane potential is relatively unchanged during the plateau phase, the potential differences in the myocardium will be small during this phase. Therefore, the ST segment should be isoelectric, which means that it should be flat and on the same level as the baseline (recall that the baseline is the level of the Figure 1 B. Figure 1. (A) The relation between the The T-wave The transition fromthe ST segment tothe T-wave is smooth, as is the transition between phase 2 and 3 of the action potential ( Figure 1 A). The T-wave represents the rapid repolarization phase (phase 3). Normal findings regarding the dire...

Medical condition Coronary ischemia Other names myocardial ischemia, cardiac ischemia Coronary arteries of the human heart Coronary ischemia, myocardial ischemia, cardiac ischemia, Symptoms and signs [ ] A key symptom of coronary ischemia is chest pain or pressure, known as Typical [ ] Angina is typically located below the Atypical [ ] Women, diabetic individuals, and elderly individuals are more likely to present with atypical symptoms other than chest pain. Causes [ ] Natural course [ ] Coronary ischemia can have serious consequences if it is not treated. Plaques in the walls of the coronary arteries can rupture, resulting in occlusion of the artery and deprivation of blood flow and oxygen to the heart muscle, resulting in cardiac cell death. Diagnosis [ ] If coronary ischemia is suspected, a series of tests will be undertaken for confirmation. The most common tests used are an [ spelling?] of chest pain or shortness of breath. The duration and frequency of symptoms will be noted as will any measures taken to relieve the symptoms. Electrocardiogram [ ] A resting electrocardiogram (EKG) is an early step in the diagnostic process. Exercise stress electrocardiogram [ ] A A Stress echocardiography [ ] Stress echocardiography is very commonly used in assessing for ischemia resulting from coronary artery disease. It can be performed exercising, preferably with a bicycle that allows the patient to exercise while lying flat, which allows for imaging throughout the entire testing...

Causes of myocardial ischemia Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries). Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms. Symptoms Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include: • Neck or jaw pain • Shoulder or arm pain • A fast heartbeat • Shortness of breath when you are physically active • Nausea and vomiting • Sweating • Fatigue When to see a doctor Get emergency help if you have severe chest pain or chest pain that doesn't go away. Development of atherosclerosis If there's too much cholesterol in the blood, the cho...

The right ventricle is supplied by the right marginal artery (r. marginalis dx), which originates from the right coronary artery (RCA). The RCA also supplies the inferior left ventricular wall in over 90% of all individuals. Hence, a proximal occlusion (in the RCA) which cuts off blood flow to the right ventricle, will also affect the inferior wall of the left ventricle in 90% of the cases. As compared with the right ventricle, the left ventricle contractsagainst much greater resistance(i.e the pressure in the systemic circulation) and therefore it faces the highest work load; for the same reason the left ventricle has the highest oxygen demand. The right ventricle and the atria work against much lower resistances and therefore have lower oxygen demands. The wall thickness is considerably thinner in the atria and right ventricle, as compared with the left ventricle. Indeed, the atrial myocardium consists of such a think layer that much of it may receive oxygen directly from blood within the atrial cavity.The left ventricle is considerably thicker and – except from the endocardium – it cannot utilize the oxygen from within the ventricular cavity. Location of acute myocardial infarction refers to the area of the left ventricle When specifying the location of myocardial infarction, reference is being made to the left ventricle. For this purpose, the left ventricle is subdivided into 4 walls: inferior, anterior, lateral and septal wall ( Figure 2below). An inferior myocardial ...

Medical condition Coronary ischemia Other names myocardial ischemia, cardiac ischemia Coronary arteries of the human heart Coronary ischemia, myocardial ischemia, cardiac ischemia, Symptoms and signs [ ] A key symptom of coronary ischemia is chest pain or pressure, known as Typical [ ] Angina is typically located below the Atypical [ ] Women, diabetic individuals, and elderly individuals are more likely to present with atypical symptoms other than chest pain. Causes [ ] Natural course [ ] Coronary ischemia can have serious consequences if it is not treated. Plaques in the walls of the coronary arteries can rupture, resulting in occlusion of the artery and deprivation of blood flow and oxygen to the heart muscle, resulting in cardiac cell death. Diagnosis [ ] If coronary ischemia is suspected, a series of tests will be undertaken for confirmation. The most common tests used are an [ spelling?] of chest pain or shortness of breath. The duration and frequency of symptoms will be noted as will any measures taken to relieve the symptoms. Electrocardiogram [ ] A resting electrocardiogram (EKG) is an early step in the diagnostic process. Exercise stress electrocardiogram [ ] A A Stress echocardiography [ ] Stress echocardiography is very commonly used in assessing for ischemia resulting from coronary artery disease. It can be performed exercising, preferably with a bicycle that allows the patient to exercise while lying flat, which allows for imaging throughout the entire testing...

Causes of myocardial ischemia Myocardial ischemia occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries). Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms. Symptoms Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include: • Neck or jaw pain • Shoulder or arm pain • A fast heartbeat • Shortness of breath when you are physically active • Nausea and vomiting • Sweating • Fatigue When to see a doctor Get emergency help if you have severe chest pain or chest pain that doesn't go away. Development of atherosclerosis If there's too much cholesterol in the blood, the cho...

• Basic anatomy & physiology • Introduction to ECG Interpretation • Arrhythmias and arrhythmology • Myocardial Ischemia & Infarction • Conduction Defects • Cardiac Hypertrophy & Enlargement • Drugs & Electrolyte Imbalance • Genetics, Syndromes & Miscellaneous • Exercise Stress Testing (Exercise ECG) • Pacemaker & CRT • Pediatric & neonatal ECG • ECHO • TAKE A TEST • POPULAR ECG in acute myocardial ischemia: ischemic ST segment & T-wave changes This chapter discusses typical and atypical changes in the ST segment and the T-wave during ST segment deviations ( T-wave changes. The reader may wish to view our video lecture on The normal ST segment and T-wave The ST segment The ST segment represents the plateau phase (phase 2) of the Figure 1 A). The plateau phase has a long duration which enables the majority of the ventricular myocardium to contract simultaneously. Sincethe membrane potential is relatively unchanged during the plateau phase, the potential differences in the myocardium will be small during this phase. Therefore, the ST segment should be isoelectric, which means that it should be flat and on the same level as the baseline (recall that the baseline is the level of the Figure 1 B. Figure 1. (A) The relation between the The T-wave The transition fromthe ST segment tothe T-wave is smooth, as is the transition between phase 2 and 3 of the action potential ( Figure 1 A). The T-wave represents the rapid repolarization phase (phase 3). Normal findings regarding the dire...

The right ventricle is supplied by the right marginal artery (r. marginalis dx), which originates from the right coronary artery (RCA). The RCA also supplies the inferior left ventricular wall in over 90% of all individuals. Hence, a proximal occlusion (in the RCA) which cuts off blood flow to the right ventricle, will also affect the inferior wall of the left ventricle in 90% of the cases. As compared with the right ventricle, the left ventricle contractsagainst much greater resistance(i.e the pressure in the systemic circulation) and therefore it faces the highest work load; for the same reason the left ventricle has the highest oxygen demand. The right ventricle and the atria work against much lower resistances and therefore have lower oxygen demands. The wall thickness is considerably thinner in the atria and right ventricle, as compared with the left ventricle. Indeed, the atrial myocardium consists of such a think layer that much of it may receive oxygen directly from blood within the atrial cavity.The left ventricle is considerably thicker and – except from the endocardium – it cannot utilize the oxygen from within the ventricular cavity. Location of acute myocardial infarction refers to the area of the left ventricle When specifying the location of myocardial infarction, reference is being made to the left ventricle. For this purpose, the left ventricle is subdivided into 4 walls: inferior, anterior, lateral and septal wall ( Figure 2below). An inferior myocardial ...

Key Points for Practice • Attempt to perform 12-lead ECG in patients with chest pain within 10 minutes of arrival to a clinic or emergency setting. • Use a clinical decision pathway to identify patients with low-risk chest pain who can be discharged from the emergency department. • If available, use CCTA preferentially over stress testing for patients with intermediate-risk chest pain to determine the need for invasive coronary angiography. For patients with high-risk chest pain, provide referral for invasive coronary angiography. • In patients with known CAD, focus on controlling blood pressure and cholesterol. Consider CCTA to document CAD progression in patients with previous testing demonstrating nonobstructive lesions. From the AFP Editors Chest pain leads to about 4 million outpatient visits per year and is the second most common reason for emergency department care, with nearly 7 million visits per year. Although most chest pain is noncardiac, more than 18 million people in the United States have coronary artery disease (CAD), leading to more than 1,000 deaths per day. The American Heart Association/American College of Cardiology (AHA/ACC) updated guidelines for management of chest pain, which are endorsed by five other cardiology groups. The guidelines provide new recommendations on what to consider chest pain and when to avoid testing in patients at low risk, and they endorse use of published decision pathways to determine the order and extent of workup. Chest pai...