10) 15 Lead part 2 Flashcards
(Coronary) left coronary artery supplies:
Left coronary artery 2 major branches are:
= L-ventricle, Intraventricular septum, part of R-ventricle & lower conductive system
= anterior descending artery and the circumflex artery
1 cause of death when having a MI
is from a lethal dysarrhythmia
12/15 Lead ECG Kev Approach) 1st.
2nd.
3rd.
4th.
5th.
6th.
7th.
8th
1st} Is there a clear isoelectric baseline? (Skin prep correctly)
2nd} Are QRSs upright leads I, II & III (Check attachment correctly)
3rd} good R wave progression? (Check lead placement)
4th} Is the monitor in the correct mode(diagnostic)? (0.05 to either 40 or 150 Hz)
5th} Is the axis normal? Any axis deviation present?
6th} Is there any ST elevation present? If yes, do you see it in 2 or more contiguous leads?
7th} Is there any ST depression? If yes, do you see it in 2 or
more contiguous leads?
8th} any pathological Q waves present? Yesterday’s news!
1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:
1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks
A Lateral Wall high view:
B Left Lateral low view:
C Inferior wall view:
D Septal wall view:
E L-Anterior view:
A= Lead I & aVL= LA
B= Lead 1, aVL, V5 & V6: views LCX & LAD
C= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
D= V1 & V2: Along sternal borders blockages from LAD commonly
E= V3 & V4: left anterior wall : LAD & LMCA blocks
3 I’S of cardiac) Pathologic Q
Infarction
3 I’S of cardiac) ST Elevation:
Injury
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
ECG Camera views) Anterior
Lead V3 V4
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
Congitual:
Reciprocal changes:
Spodicks sign:
= same view leads
= mirrored effect in oppisute/corresponding leads for sure MI
= pericarditis PR slopes down aka STEMI imposter
ECG Camera views) Left Lateral
Lead I, aVL, V4, V5
ECG Camera views) Left Lateral
Lead I, aVL, V4, V5
ECG Camera views) Septal
Lead V1 V2
ECG Camera views) LMCA - 3 vessel disease
Lead aVR
ECG Camera views) Posterior
Lead V5 V6
ECG Camera views) Right
Lead V4R
ECG Lead coronary arteries) Anterior
(LAD) Left Anterior Descending
ECG Lead coronary arteries) Inferior
(RCA) Right Coronary Artery
ECG Lead coronary arteries) Posterior
(RCA) Right Coronary Artery &/or (LCX)
ECG Lead coronary arteries) Right
(RCA)
ECG Lead coronary arteries) Lateral
(LCX) Left Circumflex
ECG Lead coronary arteries) Anterior
(LAD) Left Anterior Descending
ECG Lead coronary arteries) Inferior
(RCA) Right Coronary Artery
ECG Lead coronary arteries) Posterior
(RCA) Right Coronary Artery &/or (LCX)
ECG Lead coronary arteries) Right
(RCA)
ECG Lead views) Lead aVR
LMCA - 3 vessel disease
ECG Lead views) Lead V5 V6
Posterior
ECG Lead views) Lead V3 V4
Anterior
ECG Lead views) Lead V1 V2
Septal
ECG Lead views) Lead I, aVL, V4, V5
Left Lateral
ECG Lead views) Lead V4R
Right
ECG Lead views) Lead aVR
LMCA - 3 vessel disease
ECG Lead views) Lead V4R
Right
Isoelectric line:
Used for:
= Down 1mV of calibration bar/ line (bottom of cal)
= ST seg depress/elevation, Hypertrophy, amplitude
STE leads criteria) Lead aVR
Lead aVL
Lead aVF
Lead aVR
Lead aVL
Lead aVF
STE leads criteria) Lead V1
Lead V2
Lead V3
Lead V1
Lead V2
Lead V3
15 leads views) Lead V4
Lead V5
Lead V6
Lead V4
Lead V5
Lead V6
15 leads views) Lead V4R
Lead V8
Lead V8
Lead V4R
Lead V8
Lead V8
STE leads criteria) Lead V4R
Lead V8
Lead V8
Lead V4R
Lead V8
Lead V8
15 leads views) Lead V4R
Lead V8
Lead V8
Lead V4R
Lead V8
Lead V8
Leads 2, 3, aVF reciprocal leads
leads 1, aVL, V1-6
Leads 1, aVL, V1-6 reciprocal leads
2, 3, aVF reciprocal leads
Leads II, III and aVF look at what part of the heart?
Inferior wall (most common blockacke(RCA)
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V3 and V4 look at what part of the heart?
L-Anteriorwall (LAD & LMCA blocks)
Precordial Posterior Lead Placement) V8(5)
V9(6):
= Mid-Scapular
= ½ way in-between the Scapula & Spine
Reciprocal leads:
3 I’S of cardiac) ST depression, Hyperacute or flipped T Wave:
Ischemia
The coronary vessels A&P
coronary vessels receive blood during diastole when the heart relaxes b/c aortic valve leaflets cover the coronary artery openings (ostia) during systole.
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
V8 & V9 STEMI criteria:
0.5mm or greater
Which coronary artery feeds the inferior wall of the heart?
Right Coronary Artery (RCA)
Which coronary artery feeds the left lateral wall of the heart?
Left Circumflex (LCX)
Wellen’s wave type A:
Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower
Highly specific for for a critical blockage of the LAD
Wellen’s wave type B:
DEEP inverted T waves V2 or V3,
De Winter’s T Waves:
V2 V3 most commonly but can happen any lead
ST depression at the J-point & upsloping ST-segments w/ tall, symmetrical T- waves in the precordial leads (LMCA or LAD occlusion)
“Hyper T w/ STD”
Spodicks sign:
sloping down P wave into QRS (evidence of pericarditis)
Printz metal angina
Coronary artery spasm usually w/ stimulant (cocaine) & then occlusion arteries
3 Is of cardiac) Ischemia:
“Infarct” Injury:
Infarction:
= Ischemia: ST depres/, Hyperacute T waves>5chest avf >10 precordial
= “Infarct” Injury: ST elevation 50%,
= Infarction: old MI; >25% Q or QRS >1SB
RPM:
LAC:
RPM: Posterior & Marginal
LAC: anterior descending circumflex
ARTsclerosis:
ARTHsclerosis:
= harding of arternia
= tunica media plaque build up in layers of media & intima pushing & narrowing lumen size,
Most common reason for MI & Stroke
ARTHsclerosis: Scab of artery can break open from intima, Body constricts, hemostasis, blocks blood flow (Asprin biggest helper antiplatelet) (R side of heart only) L side Lungs filters clots)
Bundle Branch A&P) Fascicle of the conduction system:
Bundle branch blocks:
= Facilitates syncytium
= ventricles out of sync
Right BBB can produce:
LBBB can produce a
a classic rsR’ (r prime) R prime “2nd version of wave”, NO BUNNY EARS
QRS complex Discordis (oppisite)
RBBB Definer turn criteria
Up defelection before J point “turning right”
LBBB Definer Turn criteria
Down deflection before J point “turning left”
Mirror Criteria
V1&2 leads (v2 most sensitive w/ R): ST depression w/ big R wave (accompany 15-20% inferior or lateral STEMI)
Posterior MI w/o post leads
V1 V2leads Mirror test
Wellens’ Syndrome:
Wellen’s wave: Deep inverted or biphasic T waves in V2 or 3
