00:01
How do we classify MI
so that's another way
of saying how bad is it?
Well number one shows you a
sub endocardial infarction.
00:10
That's a non-STEMI is what
it would look like on an EKG.
00:14
So non-STEMI,
that's a non-st
segment elevation MI.
00:19
Now look where it is.
00:20
It's kind of the farthest in
the deepest to the tissue,
but it's just sub endocardial.
00:26
The second one I want to talk to you
about is an intramural infarction.
00:31
Now this is also
an NSTEMI but look where
it's located in the drawing
kind of right in the
center, right?
It's not sub into cardio,
It's not external.
00:39
It's right there in the middle.
00:41
That's an intramural infarction.
00:44
Now number three shows you
a transmural infarction
this one is the most serious
has the highest risk
of complications.
00:52
That is a STEMI
an ST segment elevation MI
and you'll see it goes
all the way through.
01:00
So you may hear hear
people refer to it
as a transmural infarction
or a STEMI same thing.
01:05
We've got this picture
here to help you understand
how these all interact.
01:10
Now number four is
another non-STEMI.
01:13
So 1, 2 and 4 are non-STEMI's.
01:16
This is a sub
epicardial infarction.
01:19
And you see where it's located.
01:21
Okay, this is another slide
that is worth your
time coming back
spending review with it
because you'll hear
these words used
in real practice all the time,
and it will be fast
when it comes out.
01:33
So you want to make sure
that when you hear these terms
you can picture in
your mind what this is
and give you a feel for severe
how the patient's damages
to the heart wall.
01:43
Number three is the
side but big winner
as having the most
serious complications.
01:49
So we talked about
non-STEMI and STEMI.
01:52
Let's look at it one more time just
to make sure it's clear for you
NSTEMI is a non-st elevation
myocardial infarction.
01:59
You'll see some ST
segment depression on EKG.
02:02
But keep in mind ST
segment depression
can also be caused by
reversible myocardial ischemia.
02:10
The stemi is the ST
segment elevation.
02:13
So that's what I
will see on an EKG.
02:16
I'll see the portion of the EKG
that represents the ST
segment will be elevated.
02:21
This is a bad deal.
02:23
So you see that ST segment
elevation on an EKG.
02:27
We know this patient is
more likely to experience
more significant damage
and have a worse prognosis
than if they'd had a non-STEMI.
02:37
Now here's that ST segment
we keep talking about
just a review for you
if you're a little bit
unfamiliar with this
or need a refresher,
you can see that we've
used colors on this slide
and they're really helpful,
because the first
color shows you
where the p waves
starts and ends
the next one shows
you the pr segment,
he gray one the QRS segment
talking about the ventricle.
03:01
Now you've got the ST segment.
03:04
So it's important that you
understand particularly
in looking at dysrhythmias
understand what normal
should look like.
03:11
You've got a nice p-wave there.
03:13
We've got a consistent
P every QRS.
03:16
Now, you're just
looking at one complex.
03:17
But if we're looking
at a whole strip,
those would be the
things we look for
a nice consistent P,
every P looks the same.
03:25
We've got a consistent
length and the pr,
the QRS and lead two
what this is will be upright
and look beautiful like that
and be the appropriate length
or width you might think
and then we'll have the
T wave as it resets,
but what I want you to focus
on right now is the ST segment.
03:43
Does that make sense to you
and can you see clearly
what a normal text book
ST segment will look like.
03:51
Now we're going to look at when
things go a little bit wrong.
03:54
I want you to see some
minimal ST segment depression.
03:57
So you'll see in there that
we've got just a little bit
of ST segment depression
is a sign of ischemia.
04:03
You see where the baseline is
what that just gives you an idea
of what a small ST
segment depression means.
04:10
Now looking at a non-STEMI.
04:13
There's a much more significant
ST segment depression.
04:16
So this is what you
would see in an EKG
during an STEMI, a non-STEMI
a non ST segment elevation MI.
04:25
It's got a little bit
bigger ST depression.
04:29
Also keep in mind
at the same time
we're evaluating this
we're drawing lab
work, we have the EKG,
and we're looking at
all kinds of factors
multiple pieces to put
this puzzle together.
04:42
Now this is what you'll expect
for an evolution of the changes
during an acute MI.
04:46
So a hyper acute
or elevated T wave
is only seen after
the onset of the MI.
04:53
So there we have normal
and that top row, normal.
04:56
Then we have a
hyper acute T wave
and then we have ST elevation.
05:02
So look at the difference
between normal and ST-elevation
compare both of those to what
you see in hyperacute T waves.
05:10
I promise Is critically important
that you understand normal
in everything in healthcare,
so you will recognize abnormal
quickly and early and
know what to do next.
05:23
Now ST segment elevation can
stick around for some days
and this T wave
inversion see it there.
05:29
You see that they
would T wave inversion
how it looks different than
what the normal one looks like.
05:35
So we've got ST
elevation in progress
T wave normalizes again.
05:40
So we Have a T wave inversion.
05:43
So T wave inversion
and Q waves may hang around for
years as a sign of an old MI,
but then we show you the difference
between ST elevation is it is improving
and when the T wave
normalizes again,
but keep in mind it could hang
around as a sign of an old MI.