Hello everyone! First topic here :) as said in the title, I have an EKG question. I am getting ready to take boards soon and I have accepted a job on a step down unit in a hospital, so I'm trying to refresh myself on cardiac.
I am an LPN but I don't have any experience with EKG's, other than how to apply the leads. And of course, we had a quick lecture on how to read EKG's in RN school but I'm still a bit confused. Please correct me if I'm wrong, but from my own research, an MI has to be in certain leads before it can be diagnosed?
I understand the basics of a STEMI and NSTEMI but I'm confused about the actual leads part. How can an MI be seen only in certain leads? I may be way off here but if someone could clarify or lead me to a good resource, I would appreciate it. Thank you!!!
Hi! Maybe I can help some. I am a paramedic (been in EMS for 10 years) and an RN. I just got my RN last week and yet to work in the hospital. However, cardiology is what I love. Limb leads go on the limbs. Remember - white on the right. Smoke over fire. These 4 electrodes (this is in the field-not in the hospital-although very similar) make up 3 leads- I, II, III. When the 6 chest electrodes (I am being very specific with terminology here - they are called V leads but they are not actually leads) are added to the chest you will have a total of 10 electrodes that creates 12 leads. Each LEAD has a positive electrode and a negative electrode. This creates 12 different images of the left ventricle shot from 12 different angles. Remember: SALLY. or actually, SALI
Septal - V1 V2
Anterior V3 V4
Lateral V5 V6 I AVL
Inferior II III AVF
An MI will show up as ST elevation (unless it is an anterior MI in which case you will see ST depression). The MI must be confirmed in 2 or more contiguous leads. Sometimes you can confirm with reciprocal changes. 12 leads are not 100% diagnostic. Labs are where the confirmation comes. However, a 12 lead is an awesome tool. Hopefully this helps and does not confuse you. I was trying to be very specific in my terminology because there is a vast difference between an electrode and a lead. This may be more than you want but when you can look at a 12 lead and see a possible MI these are the things we use as paramedics. Axis deviation is also helpful but I will save that. Last thing: The reason you see ST depression rather than elevation in the anterior leads is because the artery is on the back side of the heart so the picture is actually "upside down" - so to speak. You can take your 12 lead and hold it in front of a mirror or flip it upside down and you can then see the ST elevation in V3 and V4.
Oh no, this is exactly the answer I was looking for, as with previous posters as well. Thank you for taking the time to share your knowledge with me! SALI will help me remember :)
Red398
30 Posts
Oh no, this is exactly the answer I was looking for, as with previous posters as well. Thank you for taking the time to share your knowledge with me! SALI will help me remember :)