EKG changes in different leads

[nsmedic393]

We have the LP12s but they arent 12 lead equiped. Within the next year they will be.

[Ridryder 911]

I agree that XII lead is definitely the optimal standard.. but, there is many that still use 3 or ground leads. That is why I like Pages's multilead system. For all of us old farts, that still remember moving leads around to see chest leads; it does make a difference, of seeing anterior wall, inferior etc.. Yes, it takes an extra 15 seconds or so and a few extra electrodes, so I save that procedure on ones that I feel that I need more diagnostics on.

There are a lot of tricks of the trade that has been used for years, that improves diagnostics and does not cost or really is difficult.

Be safe,

R/R911

[EMS49393]

I guess Paramedics are no longer taught Mcl1 anymore............

Bob Page teaches to "monitor" in Mcl1 not lead II :!: ... His book is well worth the investment. Bob is also a renowned speaker throughout the country. Check your local conferences, he might be coming to a town near you!

[andymascall]

Those of you who use 12 lead ekg's - A quick rule of thumb is:

ST elevation > 1mm in:~

Lds I , aVL = lateral MI

Lds II, III, aVF = Inferior MI

Lds V1, V2 = Ant / Post MI

Lds V3, V4 = Ant / Septal MI

Lds V5/ V6 = Ant / Lateral MI

Have a whole load of stuff on this is anyome is interested

Another quick note is to be careful with AV paced and V paced patients as they can have "artificial" ST elevation due to the location of their pacing wires

Andy

[flight-lp]

Lds V1, V2 = Ant / Post MI

Lds V3, V4 = Ant / Septal MI

Uh, NO! V1 and 2 are your septal leads, V3 and 4 are your anterior leads. V7 through 9 will give you your posterior view.......

[andymascall]

not according to the training we had from Boehringer Ingelheim - the manufacturer of tenectaplase - In their slides for location of infarct combinations V1+2 show anterior/posterior and V3+4 show Anterior/septal

Theres my justification - check it out I think you will find I am right - if not send me a link to check it out - hate to think the literature they taught us with was wrong!!

[zumjus]

I agree with flight-lp. V1-V2 show Septal. Now v1/v2 can give a suspicion of posterior MI if you have exaggerated/tall R waves with depression (assuming you don't have the RsR pattern associated with RBBB). This would be the reciprocal view of the posterior wall. You can do a quick "mirror" look by turning the EKG backwards and upside down to look, but a more conclusive view would be v7-v9. Unfortunately I don't know of a good link other than http://www.anaesthetist.com/icu/organs/heart/ecg/ You may find info there. Generally speaking leads II, III, and AvF are considered inferior leads. v1-v6, I, and AvL are considered anterior. More specifically it is as follows:

II,III,AvF: Inferior

v1-v2: Septal/Anterior

v3-v4: Anterior (true)

v5-v6: Lateral/Anterior (Low Angle)

I, AvL: Lateral/Anterior (High Angle)

AvR: Endocardial

Rv4: Right Ventricular (can also utilize Rv3, Rv5, Rv6)

Pv7, Pv8, Pv9: Posterior

I believe this standard is pretty much universal with a little variance here and there. I hope this helps.

[kevkei]

not according to the training we had from Boehringer Ingelheim - the manufacturer of tenectaplase - In their slides for location of infarct combinations V1+2 show anterior/posterior and V3+4 show Anterior/septal

Theres my justification - check it out I think you will find I am right - if not send me a link to check it out - hate to think the literature they taught us with was wrong!!

The literature they taught you was wrong, or misinterpreted. What might have been suggested is if you have ST depression in V1/V2, it may be a reciprocal change to a posterior MI, and is worth looking at inferior leads (II, III, aVf) and V4r (right ventricle).

V1/V2- septal

V3/V4- anterior

V5/V6- lateral

I/aVl- lateral

II/III/aVf- inferior

V8/V9- posterior

V4r- right ventricle

[Punisher]

I was taught the same thing Andy was when I was trained as a cardiology technician and also when I became an ACLS instructor the materials stated V1/V2 were anterior leads, but there wasa caveat that in some cases there would be individual variability as far as what leads represent anterior vs. septal segments of the myocardium. This is simply due to variations in the anatomy of a person who is tall and thin (the heart tends to lay more midline in these persons) than in someone who is short and fat (where the diaphragm and the abdominal contents tend to lateralize the ventricles somewhat). There is also the issue of patient positioning- the effect of semi-Fowlers vs. supine positioning of a patient will effect to a variable degree how the heart is positioned at the time the EKG is done.

[flight-lp]

O.k. then both of you were trained incorrectly or the material was misinterpreted. AHA - ACLS Providers Manual states that V1 and 2 are SEPTAL Leads, 3 and 4 are your anterior leads. Plus I wouldn't put a whole lot of faith in info given to me by a for profit drug company, they tend to "stretch" the truth.