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ECG - Ischaemic Heart Disease

STEMI

1st Hyperacute T waves
2nd ST elevation with reciprocal ST depression
3rd T wave inversion
4th Loss of R wave height
5th Q waves develop: these signify transmural infarction which acts as an electrical window allowing the depolarisation of the opposite myocardium

NSTEMI

Widespread ST depression
ST-T changes
No changes

Ischaemia

ST depression
T wave changes
Deep Inverted T waves - can often indicate severe coronary artery disease in that territory e.g. Deep anterior T wave inversion - LAD stenosis and Deep inferior T wave inversion - suggests RCA stenosis

Correlating ECG and Culprit vessel- there is much variation.

Arterial occlusion ECG leads affected with ST elevation, T wave inversion, Q waves

Left anterior descending V1-V4

Circumflex V1 - reciprocal e.g. tall R wave instead of Q waves and ST depression rather than elevation (True posterior)

Right coronary artery ST elevation, T wave changes, Q waves in II, III, aVF (inferior)

Distal RCA/Side branch of Cx Lateral V5/6 changes (lateral)

Proximal LAD V1-6, I, aVL anterolateral

Proximal RCA II,III,avF, V5,V6 inferolateral

Proximal RCA/CX II,III,aVF dominant R wave in V1 (inferoposterior)

Proximal RCA/CX II,III,aVF dominant R wave in V1, V5,V6 (inferoposteriolateral)

Arterial occlusion	ECG leads affected with ST elevation, T wave inversion, Q waves
Left anterior descending	V1-V4
Circumflex	V1 - reciprocal e.g. tall R wave instead of Q waves and ST depression rather than elevation (True posterior)
Right coronary artery	ST elevation, T wave changes, Q waves in II, III, aVF (inferior)
Distal RCA/Side branch of Cx	Lateral V5/6 changes (lateral)
Proximal LAD	V1-6, I, aVL anterolateral
Proximal RCA	II,III,avF, V5,V6 inferolateral
Proximal RCA/CX	II,III,aVF dominant R wave in V1 (inferoposterior)
Proximal RCA/CX	II,III,aVF dominant R wave in V1, V5,V6 (inferoposteriolateral)

ECG References

See Excellent EKG resource

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