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The use of additional ECG leads like right-sided leads V3R and V4R and posterior leads V7, V8, and V9 may improve sensitivity for right ventricular and posterior myocardial infarction. In spite of these limitations, the 12 lead ECG stands at the center of risk stratification for the patient with suspected acute myocardial infarction.
At least 10% of patients with STEMI do not develop myocardial necrosis (as evidenced by a rise in cardiac markers) and subsequent Q waves on EKG after reperfusion therapy. Such a successful restoration of flow to the infarct-related artery during an acute myocardial infarction is known as "aborting" the myocardial infarction.
Acute coronary syndrome is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels): [4] ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina. [5]
CK-MB starts to rise 2-4 hours after infarction, peaks around 24 hours, and returns to normal after 48 hours. Since CK-MB returns to normal more quickly, it can be useful to diagnose reinfarction, a second infarction that happens after 48 hours but before troponin levels go back to normal. A second heart attack happens following 10% of MIs.
A normal ECG does not rule out acute myocardial infarction. Mistakes in interpretation are relatively common, and the failure to identify high risk features has a negative effect on the quality of patient care. [12] It should be determined if a person is at high risk for myocardial infarction before conducting imaging tests to make a diagnosis ...
Electrocardiogram showing left bundle branch block and irregular rhythm due to supraventricular extrasystoles. A left bundle branch block. LBBB is diagnosed on a 12-lead ECG. In adults, it is seen as wide QRS complexes lasting ≥120ms with characteristic QRS shapes in the precordial leads, although narrower complexes are seen in children. [4]
Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity to assess a patient's condition relative to their cardiac rhythm.Cardiac monitoring is usually carried out using electrocardiography, which is a noninvasive process that records the heart's electrical activity and displays it in an electrocardiogram. [1]
Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. [45] A number of tests can help diagnose arrhythmia, including an electrocardiogram and Holter monitor. [47] Most arrhythmias can be effectively treated. [43]