12 Leads Made Easy
12 Leads Made Easy
STEMI 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
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
R
Q 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!
Practice 12 Leads
Practice 12 Leads
Practice 12 Leads
Practice 12 Leads
Practice 12 Leads
Practice 12 Leads
