12 Lead / ACS

Question 1

Hyperkalemia ECG notes

Answer 1

Big, tall, pointed T waves
QRS might start to widen

Question 2

Inferior MI leads

Answer 2

II, III, aVF
Do right sided ECG

Question 3

Lateral MI leads

Answer 3

High lateral - I, aVL,
Low lateral - V5, V6

Question 4

Septal MI leads

Answer 4

V1, V2

Question 5

Anterior MI leads

Answer 5

V3, V4

Question 6

Pathologic Q waves

Answer 6

Sign of STEMI usually after 6 hrs
>1/3 of R wave (in down direction)
>40 ms in duration (looks like it can hold water)

Question 7

Axis deviation

Answer 7

QRS orientation:
Extreme right axis deviation- I & aVF both down
RAD - I down, aVF up
Normal - I & aVF both up
LAD - I up, aVF down

Question 8

Types of ACS on ECG

Answer 8

STEMI/LBBB
ST Depression/T wave inversion (or unstable angina)
Normal ECG findings

Question 9

Coronary artery anatomy levels (3)

Answer 9

Outside to inside:
Tunica adventitia, tunica media, tunica intima

Question 10

Atherosclerosis

Answer 10

Build up/hardening of fat within coronary artery

Question 11

Arteriosclerosis

Answer 11

Hardening/thickening of arterial wall
Lose elasticity

Question 12

Complete occlusion vs incomplete occlusion on ECG

Answer 12

Complete - STEMI/sudden death
Incomplete - NSTEMI/unstable angina/sudden death/asymptomatic

Question 13

Ischemia vs injury vs infarction

Answer 13

Ischemia - inadequate blood supply to muscle
Injury - ischemia is damaging muscle
Infarction - muscle death from ischemia

Question 14

Ischemia

Answer 14

Delays Repolarization
ST depression and T wave inversion (NSTEMI or UA)

Question 15

Injury on ECG

Answer 15

ST elevation in leads facing affected area

Question 16

Infarction

Answer 16

Myocardial muscle death
Pathologic Q waves after 6ish hours

Question 17

Stable angina s/s

Answer 17

Predictable symptoms, pt knows “I get like this after an activity”
Usually resolves with rest/normal medication doses

Question 18

Unstable angina s/s

Answer 18

Unprecedented symptoms
New onset/more severe
More NTG/meds needed to resolve issue (usually takes 0-1 but needed 3 to resolve issue)
Symptoms at rest/sleep

Question 19

ACS Presentation

Answer 19

75-80% w/ chest discomfort
Nausea/vomiting, SOB, weakness/dizziness, anxiety, syncope/lightheadedness

Consider zofran for nausea

Question 20

ACS atypical presentation

Answer 20

Elderly: less likely to have ST elevation, watch for altered mental status
Diabetics: silent AMIs (neuropathic disease alters pain perception), altered mental status
Women: back, shoulder, neck, pressure (squeezing), burning, sharp

Question 21

Condition that imitate/obscure view of MI

Answer 21

BBB, LV hypertrophy, IVR, paced rhythms,

Question 22

When the pt clutches a fist to their chest

Answer 22

Levine sign

Question 23

Inferior MI Tx

Answer 23

Right side ECG, give volume not NTG
RV MI might present w significant hypotension