CCU

S𝐮𝐫­𝐠𝐢­𝐜𝐚𝐥 T𝐢𝐦­𝐢𝐧𝐠 F𝐨𝐫 I𝐧­𝐟𝐞𝐜­𝐭𝐢𝐯𝐞 E𝐧­𝐝𝐨­𝐜𝐚𝐫𝐝𝐢­𝐭𝐢𝐬
🌀 2023 ESC GUIDELINE =================================

𝐈𝐧𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 𝐒𝐮𝐫𝐠𝐞𝐫𝐲 𝐢𝐧 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐯𝐞 𝐄𝐧𝐝𝐨𝐜𝐚𝐫𝐝𝐢𝐭𝐢𝐬
𝐓𝐡𝐞𝐫𝐞 𝐚𝐫𝐞 𝐅𝐨𝐮𝐫 𝐦𝐚𝐢𝐧 𝐫𝐞𝐚­𝐬𝐨𝐧𝐬 𝐭𝐨 𝐮𝐧­𝐝𝐞𝐫­𝐠𝐨 𝐬𝐮𝐫𝐠𝐞𝐫𝐲
𝐢𝐧 𝐭𝐡𝐞 𝐬𝐞𝐭­𝐭𝐢𝐧𝐠 𝐨𝐟 𝐀𝐜𝐮𝐭𝐞 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐯𝐞 𝐄𝐧𝐝𝐨𝐜𝐚𝐫𝐝𝐢𝐭𝐢𝐬 𝐈𝐄:

𝐄𝐧𝐮𝐦𝐞𝐫𝐚𝐭𝐞𝐝 𝐢𝐧 𝟒 𝐀𝐥𝐠𝐨𝐫𝐢𝐭𝐡𝐦𝐬 ••••

𝟏️⃣ 𝐇𝐞𝐚𝐫𝐭 𝐅𝐚𝐢𝐥𝐮𝐫𝐞

𝟐️⃣ 𝐏𝐫𝐞­𝐯𝐞𝐧­𝐭𝐢𝐨𝐧 𝐨𝐟 𝐒𝐞𝐩­𝐭𝐢𝐜 𝐄𝐦­𝐛𝐨𝐥𝐢𝐳𝐚­𝐭𝐢𝐨𝐧
(𝐢𝐧 𝐩𝐚𝐫­𝐭𝐢𝐜­𝐮­𝐥𝐚𝐫, 𝐜𝐞𝐫𝐞­𝐛𝐫𝐚𝐥 𝐞𝐦­𝐛𝐨𝐥𝐢)

𝟑️⃣ 𝐔𝐧­𝐜𝐨𝐧­𝐭𝐫𝐨𝐥𝐥𝐞𝐝 𝐈𝐧­𝐟𝐞𝐜­𝐭𝐢𝐨𝐧

𝟒️⃣ 𝐑𝐞𝐬𝐢𝐬𝐭𝐚𝐧𝐭 𝐁𝐚𝐜𝐭𝐞𝐫𝐢𝐚 𝐨𝐫 𝐅𝐮𝐧𝐠𝐢

𝐓𝐢𝐦­𝐢𝐧𝐠 𝐨𝐟 𝐬𝐮𝐫𝐠𝐞𝐫𝐲 𝐜𝐚𝐧 𝐛𝐞
===================
• 𝐄𝐦𝐞𝐫­𝐠𝐞𝐧­𝐜𝐲 (𝐰𝐢𝐭𝐡­𝐢𝐧 𝟐𝟒 𝐡),
• 𝐔𝐫­𝐠𝐞𝐧𝐭 (𝐰𝐢𝐭𝐡­𝐢𝐧 𝟑–𝟓 𝐝𝐚𝐲𝐬) 𝐨𝐫
• 𝐍𝐨𝐧-​𝐮𝐫­𝐠𝐞𝐧𝐭 (𝐰𝐢𝐭𝐡­𝐢𝐧 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐡𝐨𝐬­𝐩𝐢­𝐭𝐚𝐥­𝐢𝐳𝐚­𝐭𝐢𝐨𝐧).

𝐏𝐫𝐨­𝐩𝐨𝐬𝐞𝐝 S𝐮𝐫­𝐠𝐢­𝐜𝐚𝐥 T𝐢𝐦­𝐢𝐧𝐠
F𝐨𝐫 I𝐧­𝐟𝐞𝐜­𝐭𝐢𝐯𝐞 E𝐧­𝐝𝐨­𝐜𝐚𝐫𝐝𝐢­𝐭𝐢𝐬. 👇
💚class I 💛class IIa. 🧡class IIb

𝐏𝐫𝐞𝐥𝐨𝐚𝐝 vs 𝐀𝐟𝐭𝐞𝐫𝐋𝐨𝐚𝐝
𝐂𝐚𝐫𝐝𝐢𝐚𝐜 𝐏𝐞𝐫𝐟𝐨𝐫𝐦𝐚𝐧𝐜𝐞

𝐋𝐞𝐟𝐭 𝐌𝐚𝐢𝐧 𝐂𝐨𝐫𝐨𝐧𝐚𝐫𝐲 𝐀𝐫𝐭𝐞𝐫𝐲 𝐎𝐜𝐜𝐥𝐮𝐬𝐢𝐨𝐧


𝙀𝘾𝙂 𝙛𝙚𝙖𝙩𝙪𝙧𝙚𝙨

▫️Widespread horizontal ST depression,
most prominent in leads I, II and V4-6
▫️ST elevation in aVR ≥ 1mm
▫️ST elevation in aVR ≥ V1

𝙎𝙏 𝙚𝙡𝙚𝙫𝙖𝙩𝙞𝙤𝙣 𝙞𝙣 𝙖𝙑𝙍 𝙣𝙤𝙩 𝙨𝙥𝙚𝙘𝙞𝙛𝙞𝙘 𝙛𝙤𝙧 𝙇𝙈𝘾𝘼 𝙤𝙘𝙘𝙡𝙪𝙨𝙞𝙤𝙣
and may indicate other conditions such as:

▫️Proximal left anterior descending occlusion
▫️Severe triple-vessel disease
▫️Diffuse subendocardial ischemia

🌊 𝙈𝙚𝙘𝙝𝙖𝙣𝙞𝙨𝙢 𝙤𝙛 𝙎𝙏 𝙚𝙡𝙚𝙫𝙖𝙩𝙞𝙤𝙣 𝙖𝙑𝙍 𝙞𝙨 𝙢𝙪𝙡𝙩𝙞𝙛𝙖𝙘𝙩𝙤𝙧𝙞𝙖𝙡:

• Reciprocal to ST depression in I,II, aVL and V4-V6

• aVR directly records electrical activity from
the right upper portion of the heart (the right
ventricular outflow tract and the basal portion
of the interventricular septum)

• Diffuse subendocardial ischemia with ST
depression in lateral leads produces reciprocal
change in aVR and infarction of the basal septum

The absence of STE in aVR almost entirely
excludes a significant LMCA lesion.

Sinus tachycardia is an often presentation
of LMCA occlusion, as patients do usually develop cardiogenic shock.