E.C.G.

Course – IV
ST – T Deviations
and QT
prolongation
Dr. Michael Kassirer

”Dept. Internal Medicine ”D

Tel-Aviv Medical center
 Objective
By the end of lesson 4 the student will:
 Be able to diagnose ST segment elevation,
identify and locate AMI, and other causes of
ST segment elevation.
 Describe the sequence of ECG events in
AMI
 Know how to diagnose ST depression.
 Understand the importance of T wave
inversion
 ECG changes in CHD -
summery
 T wave inversion –
Ischemia
 ST deviation:
– Elevation – Injury
(trans-mural)
- Depression –
Ischemia (Sub-
endocardial).
- Reciprocal Infarct Injury Ischemia
changes
 QRS: Infarct

– decreased R
- Q wave
The QRS complex – V.
depolarization

V1 V6

L3 L2
The QRS complex – V.
depolarization

V1
V1 V6

L3 L2
The QRS complex – V.
depolarization

V1
V1 V6

L3 L2
 The QRS complex – V.
depolarization

V1
V1 V6

L3
L3 L2
 ST changes in Ischemia
))Phase 2 changes
Injur Ischemia
y

V1 V6 V1 V6

L3 L2
L3 L2
AMI – ECG evolution
 ST elevation and MI
location
ST ↑ in leads…Position Occ. Artery
V1-3 Anterior LAD
V2-4 Septal/Apical mid LAD
V5-6 (± L1, aVL) Lateral LCx or D1/M1
V1-6 Ext. Antrior L.M or Prox. LAD
Inferior (RCA (80%
L2, L3, aVF
High lateral M1 or D1
L1, aVL
Posterior LCx
V7-9 RV RCA
V2R-4R
?Where is the MI
?Where is the MI
?Where was the MI
 ST elevation – non AMI

arly repolarization Pericarditis

ST elevation – non AMI

L.B.B.B Hyperkalemia
ST - T depression
 T wave inversion
 Evolving MI/NSTEMI
 Old MI
 Myocarditis
 LVH/RVH strain
 Cerebral T wave
 T wave inversion

LVH/RVH + Strain Digitalis effect