12 Leads Made EasySTEMI Recognition Class

Michael D. Murley

12 Leads Made Easy

Module 1 – Introduction to 12 Leads

Module 2 – Learn to Identify the J Point

Module 3 – Learn to identify ST Elevation

Module 4 – Lead Views

Module 5 – Game for review

Module 6 – Putting it all together, STEMI Recognition

Module 1 Intro to 12 Lead

Most 12 Leads have this common layout

Module 1 Intro to 12 Lead

4 Columns

Module 1 Intro to 12 Lead

3 Rows

Module 1 Intro to 12 Lead

Module 1 Intro to 12 Lead

Practice filling in the Leads

Module 1 Intro to 12 Lead

Module 2 Learn to ID the J Point

STEMI

Module 2 Learn to ID the J Point

Achieved by obtaining a rapid 12 Lead ECG

Module 2 Learn to ID the J Point

While it is possible to identify Myocardial Infarction by clinical presentation,

Lead II = No Clue

Module 2 Learn to ID the J Point

We will learn how to:

• Locate the ST Segment

• Identify which parts of the ST Segment we use for analysis

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Junction Point or J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Module 2 Learn to ID the J Point

Now that you know how to find the J Point, let’s learn how to find J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Don’t compare J Point to the PRI segment, there are medical conditions that my cause PRI depression

Module 3 Learn to ID J Point elevation

Your eye wants to compare it to the PRI, but that’s not best reference point

Module 3 Learn to ID J Point elevation

The TP segment provides the best baseline to evaluate ST elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Let’s practice finding the J Point and check for elevation/depression

Module 3 Learn to ID J Point elevation

Let’s practice finding the J Point and check for elevation/depression

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Learn to ID J Point elevation

Module 3 Review

We’re half way there. In order to recognize STEMI you have to know 2 things

• What to look for (ST elevation)

• Where you are looking (which Lead)

Module 4 Lead Views

In Module 4 we will learn which part of the heart that each lead sees.

Module 4 Lead Views

There are many different leads with many different features

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

The heart is not oriented vertically in the chest

Left Ventricle is Cone shaped and it rest on the diaphragm

Left Ventricle is divided into 5 regions

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

• Posterior

Module 4 Lead Views

The QRS complexes are created primarily by the electrical activity occurring in the Left ventricle

Q

R

S

You can think of each Lead as seeing a different portion of the Left ventricle

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

Module 4 Lead Views

The criteria for a STEMI is ST segment elevation in two or more contiguous Leads

Module 4 Lead Views

Only for ventricular Leads

Module 4 Lead Views

V1 V2

V3

V4 V5 V6

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 5 Review

Module 6 STEMI Recognition

Now we know what we are looking for (ST elevation) and where we are looking (Lead views)

It’s time to put it all together by taking a step by step approach to reading 12 Lead ECG’s

Module 6 STEMI Recognition

Interrupting the 12 Lead requires you to go Lead by Lead, selecting one good representative complex

Module 6 STEMI Recognition

Pick one with a good baseline to compare and DON’T select a PVC or any ectopic complex for analysis

Module 6 STEMI Recognition

Pick one with a good baseline to compare and DON’T select a PVC or any ectopic complex for analysis

Module 6 STEMI Recognition

Once you have your complex, find the J Point and determine if ST elevation is present

Module 6 STEMI Recognition

Check each Lead, one by one, throughout all the Leads except aVR. When you’re down, answer this question

Module 6 STEMI Recognition

If so, suspect STEMI

Module 6 STEMI Recognition

Module 6 STEMI Recognition

Let’s practice

Module 6 STEMI Recognition

Module 6 STEMI Recognition

Module 6 STEMI Recognition

Module 6 STEMI Recognition

Module 6 STEMI Recognition

Congrats! Let’s practice!

Let’s Practice

Practice 12 Leads

Practice 12 Leads

Practice 12 Leads

Practice 12 Leads

Practice 12 Leads

Practice 12 Leads

FIN