High Yield Cardiology Image Based Question

Diagnosis- Inferior wall MI with ST elevation in II, III and aVF Heart Rate

HR= 100/min  if there are three huge squares between RR. Lead I has a larger R wave than S wave; Lead II has a classical pardee sign; Lead III and aVF show ST segment elevation; as a result, the clinical diagnosis will be inferior wall MI. The vector for Lead I & aVF is positive, implying the axis is a normal axis. P wave, QRS complex, and PR intervals are normal. 

The RCA block is the cause of inferior wall MI.  Involvement of the vagus nerve : Vomiting , HR↑, BP↑, RVF and absence of pulmonary edema
Lead II, III, and aVF = ST elevation > 2 mm in men and > 1.5 mm in women;: In acute coronary syndrome, morphine, oxygen, aspirin, and NTG  (MOAN) are administered. For SBP less than 80 mmHg,  NTG is C/I.,  In inferior wall MI, IV metoprolol is C/I.

Management: Atropine for HR; IV fluids for SBP (unrecordable).

Diagnosis: Anterior wall MI

The axis is the normal axis when there are four huge squares between R-R=75/min · Vector in lead I, R-S is positive, and aVF R-S zero.

Lead I, V2, V3, and V4 show the ST segment elevation. Tombstone pattern-(ST elevation with hyperacute T waves) .Given that the patient is diabetic, this is most likely a silent MI case. Sudden death in diabetic patients - Causes :Silent MI , Hypoglycemia ignorance.

Also Read: Aortic Aneurysm- Thoracic And Abdominal Aortic Aneurysm

Types of ST segment elevation

ST Segment elevation

 ST Segment elevation concavity is seen in Acute pericarditis.

Causes of ST elevation

• Electrocyte: K↑
• LBBB
• Early repolarization variant
• Ventricular Aneurysm (Structural damage seen post MI)
• Trauma: Pericardiocentesis
• Ischemic injury due to MI
• Osbourne wave due to hypothermia
• Non-occlusive vasospasm encountered with Prinzmetal angina.

(Mnemonic: ELEVATION)

ST Segment Depression

Causes

• Chronic stable angina
• Digoxin
• K↓
• LVH due to aortic stenosis/ HOCM/ HTN

Also Read: Polymorphic Ventricular Tachycardia, Repolarization Abnormality and Genetic Arrhythmia Syndrome 

Must Know ST Segment changes

Brugada Sign

T wave inversion occurs after ST segment elevation in Brugada syndrome. It is caused by the gene SCN-5A and is a channelopathy (Na channel deficiency) that can result in sudden cardiac death.

Hockey Stick sign

Seen in Digoxin. The MRI hockey stick sign is indicative of variant Creutzfeldt-Jakob disease. Mitral stenosis is the cause of the hockey stick indication in the ECHO. Ventricular Bigeminy is caused by digoxin poisoning.

Diagnosis: Atrial fibrillation

No P Wave .  An abnormal R-R interval, observed in patients with atrial fibrillation. QRS duration Ⓝ /↓· MC persistent arrhythmia, which is Atrial fibrillation. Atrial fibrillation alterations are observed in lead II, III, and aVF . Saw tooth waves succeeded by narrow QRS.

Diagnosis: Monomorphic ventricular tachycardia

Pulselessness and blood pressure drops after MI are caused by hypoxia. This condition is also present in ventricular tachycardia and fibrillation. 

The ECG displays- Wide complex QRS with nearly equal amplitude, supporting the diagnosis of monomorphic VT. 

Management- Amiodarone for stable VT · Pulseless VT: Cardio version- DC shock of 200 joules non-synchronized.

Non-synchronized DC shock is given under 2 conditions

• Ventricular tachycardia
• Ventricular fibrillation

Polymorphic ventricular tachycardia (torsade de pointes):

MgSO4 (DOC)

Hope you found this blog helpful for your NEET SS Medicine Cardiovascular Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.