💓ECG झाला सोप्पा💓 भाग - 11 वा

💓ECG झाला सोप्पा💓
भाग - 11 वा

🌹डॉ पद्मनाभ केसकर
Emergency Management Expert , Pune
मोबाईल - ९७६२२५८६५०

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✅सध्या आपण ECG मध्ये ST segment related abnormalities काय काय मिळतात त्या कशा ओळखायच्या , त्याची कारणे व त्याची ट्रीटमेंट बघत आहोत . मागील दोन भागापासून आपण ST segment Elevation या भागाला सुरुवात केली होती . ST segment Elevation च्या कारणांपैकी STEMI म्हणजे ST segment Elevated Myocardial Infarction चे निदान व प्रकार व ट्रीटमेंट विषयी आपण माहिती घेतली होती. तसेच ST SEGMENT Elevation च्या अन्य कारणांची आपण चर्चा चालू केली होती.  याच संदर्भामध्ये पुढील कारणांची आपण चर्चा या भागात चालू ठेवणार आहोत.

💟Pericarditis

Pericarditis means Inflammation of the pericardium that causes chest pain and accumulation of fluid around the heart (pericardial effusion).

Pericarditis च्या ECG मध्ये पण ST Elevation आढळते पण त्याचे वेगळेपण म्हणजे Widespread Concave प्रकारचे असते ( Saddleback appearance )

 
©️ Dr Padmanabh Keskar

How To Recognise Pericarditis

1) Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).

2) Reciprocal ST depression and PR elevation in lead aVR (± V1).

3) Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion.

खालील ECG मध्ये बघा

PR depression and ST elevation in V5

Reciprocal PR elevation and ST depression in aVR

Above is Typical example of ECG of pericarditis

Widespread ST elevation ( Concave “saddleback” ST elevation )and PR depression
Reciprocal ST depression and PR elevation in V1 and aVR
Spodick’s sign was first described by David H. Spodick in 1974 as a downward sloping TP segment with specificity for acute pericarditis.

💓How to distinguish Pericarditis from STEMI on ECG:

©️ Dr Padmanabh Keskar

Three questions:
1.    Is there ST depression in a lead other than aVR or V1? If YES, it’s a STEMI
2.    Is there convex up or horizontal ST elevation? If YES, it’s a STEMI
3.    Is the ST elevation in lead III greater than the ST elevation in lead II? If YES, it’s a STEMI

🍂Benign Early Repolarization🍂

ही Abnormality बरेचदा तरुण लोकांच्या ECG मध्ये नॉर्मल variant म्हणून बघायला मिळते .

STEMI आणि BER मध्ये फरक कसा करायचा ?
©️ Dr Padmanabh Keskar

Benign Early Repolarization (BER) causes mild ST elevation with tall T-waves mainly in the precordial leads. There is often notching of the  J-point —the “fish-hook” pattern.
( खालील ECG बघा )

The ST changes may be more prominent at slower heart rates and disappear in the presence of tachycardia.

🍁Brugada Syndrome🍁

©️ Dr Padmanabh Keskar

Brugada सिन्ड्रोम हा एक हेरीडिटोरी ऍबनॉर्मलिटी आहे यात तरुण पेशंट मध्ये paroxysmal ventricular arrhythmias होऊन sudden cardiac death होते .

The tell-tale sign on the resting ECG is the “Brugada sign” — ST elevation and partial RBBB in V1-2 with a “coved” morphology. ( खालील ECG बघा )

🍁Some other ST Elevation Abnormalities 🍁

💥 Ventricular Aneurysm 

Below is ECG pattern of Ventricular Aneurysm. Residual ST ELEVATION and deep q wave seen in patients of previous Myocardial Infarction.  It is associated with extensive Myocardial damage and Parodoxical movement of left ventricular wall during Systole .

💥 Raised Intracranial Pressure 

See below ECG 

Widespread ST ELEVATION with Concave ( Pericarditis like ) morphology in a patient with severe traumatic brain injury . With deep T wave inversion ( Cerebral T waves ) 

🍁Some ST Elevation wave forms 🍁

🍁Less common abnormalities of ST Elevation found in ECG 

©️ Dr Padmanabh Keskar

💟Pulmonary embolism and acute cor pulmonale (usually in lead III)

💟Acute aortic dissection (classically causes inferior STEMI due to RCA dissection)

💟Hyperkalaemia

💟Sodium-channel blocking drugs (secondary to QRS widening)

💟J-waves  (hypothermia , hypercalcaemia)

💟Following electrical cardioversion

आज इथेच थांबू .

पुढील भागात ST डिप्रेशन विषयी चर्चा करू

( क्रमशः )

🌹डॉ पद्मनाभ केसकर
Emergency Management Expert , Pune
मोबाईल - ९७६२२५८६५०