11) 15 lead ECG Flashcards
Axis)
Normal axis:
Lead views:
= Direction of travel of electrical impulses moving in heart
= downward & toward the left (way heart sits) 0 to +90
= L1-3 + QRS, + camera at flow of electricity
Axis) Phycological seen w/:
Lead 1 view:
Lead 2 view:
Lead 3 view:
= not big deal (younger, obese, athletes, preganent)
= up / positive
= can show upward or halfway deflection
= down / negative
Axis) Pathological L-Axis:
Remember:
= Suggests anterior hemiblock, “Up down down”
=Hemi 1 of BBB of L blocked (post only feed by LAD)Electricity, 4x > likely arrest w/ hemiblock & “chest pain”, LAFB most common & concerning
Axis) Extreme Right deviation :
Origin:
Leads, I, II, III
Caused by:
VT criteria:
= impulse coming from ventricles to R-atrium “aint right”
= Indeterminate axis, Usually ventricular in origin
= Down/- in all three leads 1-3
= VT} ventricular rhythms/PVCs,
= V6 -, & +1
Axis) Right-Deviation:
Associated w/:
Lead views:
Causes:
= “Right ax aint right” (posterior fascicular block) Rare occurrence in adults (sometimes seen in kids)
= Almost always pathological, Associated w/ posterior hemiblock, Massive PEs & MI can show
= Lead I down & Lead III up “Down down up”
= PE, RVH, LPFB, RHF, COLD, Dextrocardia, Ectopic beats, Pulmonary HTN, Normal in children, Pulmonary valve stenosis
HB) Fascicular Block (Hemiblock):
ECG diagnosis:
Occlusion of:
Mortality rate when w/ AMI:
= block of 1 of the 2 fascicles of L-bundle (LAD)
= Based on Pathological L-axis deviation
= LMCA partial occlusion or LAD occlusion
= 4x higher (Proximal occlusion until proven otherwise)
HB) Posterior Hemiblock:
Axis:
Severity & mortality:
= (usually dub block) not common, silent killer
= Right axis deviation
= Very high mortality w/ AMI & Serious prob/ involving 2 coronary arteries
Sgarbossa’s Criteria:
Discordice:
LBBB & V pacer discordice is:
= ventricular pacer & LBBB} 1 & 2!, 3 eh so smith modified
= big neg QRS w/ Monst T = opposites
= NORMAL (concordance bad)
Ventricles contract:
Atriums contract:
= inferior to superior
= superior to inferior
LBBB) QRS & ST Segment:
between the QRS complex & ST-Seg/:
If QRS is pointing up, ST- Seg/:
If QRS is pointing down, ST- Seg/:
= QRS>0.12Secs, V1 QRS neg/ & broad, V6 QRS + & broad
= Discordant (commonly L-deviation) “2dry repolar/ changes”
= should be pointing down
= should be pointing up
Sgarbossa Criteria) #1:
Criteria #2:
= STE ≥1mm concordant w/ QRS direction in ANY lead
Sgarbossa Criteria) Criteria #2:
= ST Depression ≥1mm concordant in leads V1, V2 or V3. (non progressive precordial)
Sgarbossa Criteria) Why do we need it?
Used for:
= LBBB normally causes STE, even when there’s no acute MI.
= Predict AMI even w/ LBBB or ventricular pacer (doesnt need 2 congitual leads)
Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:
3 points “def an MI:
Weakest Predictor – 2 points:
= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead
Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:
3 points “def an MI:
Weakest Predictor – 2 points:
= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead
Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:
3 points “def an MI:
Weakest Predictor – 2 points:
= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead
Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:
3 points “def an MI:
Weakest Predictor – 2 points:
= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead
Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:
3 points “def an MI:
Weakest Predictor – 2 points:
= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead
Sgarbossa Criteria) Smith -modified:
Formula:
= measuring over sizing.
= ST/QRS Ratio >0.2 criteria 3
3rd-degree heart block, ECG findings
P waves and QRS complexes are completely independent
Sgarbossa’s criteria is only utilized w/ what:
Left Bundle Branch Block & Ventricular pacer
Regular rhythm at 50 BPM, QRS > 0.12 seconds, no P waves
Accelerated Idioventricular Rhythm
Most 2 common cause of PEA in adult cardiac arrest?
Hypovolemia & Hypoxia
Med 1st-line treatment for stable SVT?
Adenosine
(tachycardia, A-Flutter w/ RVR, AF w/ RVR) which is most likely to respond to synchronized cardioversion?
Atrial fibrillation w/ RVR
Correct initial dose of adenosine for SVT?
correct 2nd dose of adenosine for SVT?
6 mg rapid IV push
12 mg rapid IV push
PT w/ chest pain, diaphoresis, & shortness of breath. Their 12-lead ECG shows STE in leads II, III, & aVF. likely indicates:
Inferior Wall MI
HR 180, BP 85/40, chest pain, & AMS. ECG shows a regular wide-complex Tachycardia. What is the most appropriate initial treatment?
A synchronized DC countershock
PT w/ a new onset of substernal chest pain. 12-lead ECG shows ST depression in V1 & V2. likely indicates:
Posterior Wall MI
Initial dose of Diltiazem?
0.25 mg/kg Slow IV with a max dose of 20 mg
Meds should be administered first in a witnessed VF arrest?
Epinephrine
