hey Mark what's going on hey dr. Kafka 嘿马克， 嘿，博士。卡夫卡
I'm just looking at this EKG I'm a new 我只是看着这个EKG我是一个新人
patient I admit it I think they're 病人我承认，我认为他们是
having an acute MI and I'm pretty sure 有急性MI，我很确定
there's ST elevation what do you think 有ST升高您的想法是什么？
well let me take a look 好吧，让我来看看
you know I am worried about acute 你知道我很担心
myocardial infarction in this patient 该患者的心肌梗死
let me call the cath lab and then we'll 让我打电话给导管实验室然后我们会
discuss the ECG findings a little 讨论心电图检查结果
further great 进一步大
st-elevation myocardial infarction or a st-elevation心肌梗死或a
STEMI is basically the complete STEMI 基本上是完整的
occlusion of a quarter ii artery in the 阻塞四分之一的动脉
heart and rapid identification of this 心脏并迅速识别这一点
can literally save your patients heart 可以从字面上拯救患者的心脏
muscle or their life now let's take a 肌肉或他们的生活现在让我们采取一个
look at this on the form of an EKG and 以EKG和EKG的形式来看待这个
the EKG here we're gonna be looking for 我们将在这里寻找 EKG
one millimeter or more ST elevation and 一个毫米或更多的ST高程和
two or more consecutive leads hey doctor 两个或多个连续导致嘿医生
chemica where should we be looking on chemica 我们应该在哪里看
the ST segment for the elevated portion 升高部分的ST段
that's a great question mark so we're 这是一个很好的问号所以我们是
looking for something called the J point 寻找一种叫做J点的东西
which is right here 就在这里
now the J point is at the end of the QRS 现在J点位于QRS的末尾
segment and at the onset of the ST 段和ST的开始
segment okay and what are we comparing 细分可以和我们比较什么
the J point to so if the J point is here 如果J点在这里，J指向如此
we're gonna compare the PR segment as 我们要把公关部门比作
our baseline which is right here okay so 我们的基线就在这里，好吧
one millimeter or more of St elevation St高程一毫米或更多
at the J point compared to the PR 在J点与PR相比
segment does the shape of the ST segment segment 执行ST段的形状
matter at all that's actually extremely 实际上非常重要
important so you have many different 很重要，所以你有很多不同
reasons to have st elevations some 有一些升高的 原因
examples are early repolarization left 例子是早期复极离开
ventricular hypertrophy or pericarditis 心室肥大或心包炎
so how do we know that we're having 那我们 怎么知道我们有
acute occlusion of a coronary artery so 因此 ， 冠状动脉急性闭塞
one if I'm looking at the normal end of 一个， 如果我正在看正常结束
the J point right here and if it's J点就在这里，如果是的话
rising over one millimeter and it's 超过一毫米，它是
either horizontally going across or if 无论是水平穿越还是如果
it's merging with the T wave and forming 它与T波合并并形成
a convex or Tombstone finding that's 凸起或墓碑发现的
more concerning for an ST elevation 更多关于为ST段抬高
myocardial infarction okay so if that's 心肌梗塞好吧，如果那样的话
convex that means that this one in front 凸起意味着这一个在前面
of me is concave and this would be less 我是凹的，这会少
concerning for an MI you got it but 关于MI，你得到了它但是
always remember to fight clinically 永远记得在临床上战斗
correlate these findings okay I think I 关联这些发现好吧我想我
understand that's the elevation a little 明白这是海拔高度
better let's talk about consecutive 更好的让我们谈谈连续
leads 引线
hey dr. Kafka I heard you talking on 嘿博士卡夫卡， 我听说你在谈论
rounds the other day about consecutive 关于连续几天的回合
leads what are those and why are they 领导那些是什么，为什么他们
important well first of all I'm 重要的是首先我是
impressed that you were actually 印象深刻的是，你实际上是
listening on rounds 听着回合
that's a first consecutive leads or 这是第一个连续的领先优势
contiguous leads are an ECGs version of 连续导联是ECG的版本
the anatomic portions of the heart okay 心脏的解剖部分还可以
and I heard you mentioned before that we 我听说你之前提到过我们
need two or more consecutively it's 需要两个或更多的连续它的
involved or an acute MI exactly we're 我们确实涉及或是急性心肌梗死
trying to take a look at a snapshot of 试着看一下快照
something in two different leads or two 两个不同的线索或两个的东西
different camera viewpoints okay so if 不同的相机观点好吧如果
we had an inferior infarct which leads 我们有一个较低的梗塞导致
would be involved so that would be two 会参与，所以这将是两个
three and ABF okay what about lateral 三，ABF还好横向
infarct lateral in parks r1 AVL v5 and 在公园r1AVL v5和
v6 okay and what about anterior septal v6 好吧，前房间隔怎么办？
Anto septal is going to be v1 and v2 Anto septal将成为v1和v2
okay and lastly what about interior 好的，最后内部怎么样
apical answer or apical in parks are 公园的顶端答案或顶端是
going to be v3 and v4 okay I think I 将是v3和v4 好吧我想我
understand consecutive leads a little 了解连续领先一点
bit better let's talk about reciprocal 更好的让我们谈谈互惠
changes okay now that we understand 现在我们明白了改变
consecutive leads a little bit better 连续带领一点点好转
let's talk about the term reciprocal 让我们来谈谈互惠一词
changes so what does that mean and why 改变那是什么意思和原因
is that important so reciprocal changes 是那么重要， 所以互惠的变化
are basically looking at the ECG on the 基本上是看心电图了
opposite side from where you're having 你所在的对面
the current of injury and they're 伤害的当前 和他们
usually in the form of an ST depression 通常以ST抑郁症的形式出现
okay so if we had an anterior ST 好吧，如果我们有一个前ST
elevation mi we would expect a posterior 海拔mi 我们期待后路
change logically that makes sense but 逻辑上改变，但有意义
remember your heart is irregularly 记住你的心脏是不规则的
shaped so when we're talking about 当我们谈论时，我们就这样塑造了
anterior ST elevation we're actually 我们实际上是前部ST段抬高
looking at the inferior portion for ST 看着ST的下部
depressions okay and likewise if you had 沮丧，如果你有，也可以
an inferior mi you would expect changes 一个劣等的mi你会期待变化
anteriorly that's correct so if you're 前面那是正确的，所以如果你是
having ST elevations and leads to three ST升高并导致三个
and a VF you're actually gonna be 你实际上是一个VF
looking anteriorly for ST depressions 向前看ST洼地
and leads v1 all the way up to possibly 并引导v1一直到可能
v4 oh okay v4 哦没关系
and what about if you had an ST 如果你有一个ST怎么样？
elevation in the lateral wall so the 因此，侧壁的高度
lateral wall is a little challenging 侧壁有点挑战性
there in your standard 12-lead ECG 在您的标准12导联心电图中
there's no great opposite side okay 对方没有好的
I think our patient earlier must have 我认为我们的患者早些时候必须有
had an anterior STEMI how did she do 有一个前STEMI 她是怎么做的
she's actually doing really well they 她居然做得非常好，他们
were able to open up her corners and 能够打开她的角落
she's recovering in the CCU 她正在CCU康复
great thank goodness we knew how to read 非常感谢我们知道如何阅读
EKGs as well 心电图也是如此