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Cardiac Emergencies > 12 lead EKG > Flashcards

12 lead EKG Flashcards

1
Q

lead 2, 3, aVF

A

-view inferior wall of heart

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2
Q

lead V1 and V2

A

-view septal wall of heart

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3
Q

lead V3 and V4

A

-view anterior wall of heart

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4
Q

lead 1, aVL, V5, V6

A

-view lateral wall of heart

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5
Q

myocardial insult: ischemia

A
  • lack of oxygenation
  • ST depression or T wave inversion*
  • permanent damage avoidable
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6
Q

myocardial insult: injury

A
  • prolonged ischemia
  • ST elevation*
  • permanent damage avoidable
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7
Q

myocardial insult: infarct

A
  • death of myocardial tissue
  • damage permanent
  • may have Q wave*
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8
Q

evaluating for ST segment elevation

A
  • locate the J point
  • identify/estimate where the isoelectric line is noted to be to
  • compare the level of the ST segment to the isoelectric line
  • elevation (or depression) is significant if more than 1 mm (one small box) is seen in 2 or more leads facing the same anatomical area of the heart
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9
Q

j point

A

-where the QRS complex and ST segment meet

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10
Q

ST segment elevation

A

-evaluated .04 seconds (one small box) after J point

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11
Q

contiguous leads

A
  • lateral wall- 1, aVL, V5, V6
  • inferior wall- 2, 3, avF
  • septum- V1 and V2
  • anterior wall- V3 and V4
  • posterior wall- V7-V9 (leads placed on the patients back 5th intercostal space creating a 15 lead EKG)
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12
Q

inferior wall

A

-positive MI makes us worried about posterior wall

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13
Q

evolution of AMI

A
  • pre-infarct (normal)
  • Tall T wave (first few minutes of infarct)
  • tall T wave AND ST elevation (injury)
  • elevated ST (injury) inverted T wave (ischemia), Q wave (tissue death)
  • inverted T wave (ischemia), Q wave (tissue death)
  • Q wave (permanent marking)
  • LOOK AT SLIDES PICTURE -> 11
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14
Q

take ur reading

A

-about a box after J point (.04s)

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15
Q

EKG monitoring

A
  • evaluates electrical activity of the heart
  • can indicate myocardial insult and location
  • ischemia- initial insult -> ST depression seen
  • injury- prolonged myocardial hypoxia or ischemia -> ST elevation seen
  • infarction- tissue death
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16
Q

infarction: tissue death

A
  • dead tissue no longer contracts
  • amount of dead tissue directly related to degree of muscle impairment
  • may show Q waves
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17
Q

contiguous ECG leads

A
  • EKG changes are significant when they are seen in at least two contiguous leads
  • two leads are contiguous if they look at the same area of the heart or they are numerically consecutive chest leads
18
Q

aVR

A
  • control lead
  • global MI - ST elevation everywhere
  • pericarditis if there is a elevation in the aVR
19
Q

heart arteries

A
  • right coronary artery
  • right ventricular marginal branch
  • posterior descending artery
  • left main coronary artery
  • circumflex artery
  • obtuse marginal
  • diagonal artery
  • left anterior descending artery (LAD)
  • arteries arnt on quiz but maybe final
  • cross over
20
Q

complications of lateral wall MI

A
  • lead 1, aVL, V5, V6
  • complication arise due to the conduction components that are in the septum
  • conduction dysrhythmias most common:
  • second degree type 2- classical
  • 3rd degree- complete heart block
  • bundle branch blocks- partial
  • monitor patient closely for these blocks:
  • 2nd degree type 2 and 3rd degree are serious dysrhythmias that need to be treated aggressively with TCP -> pacemaker
21
Q

complications of inferior wall MI

A
  • lead 2, 3, aVF
  • 40% of patients with inferior MIs have right ventricular infarcts
  • in the presence of a right ventricular infarct, there is a high likeliness of both ventricles being damaged
  • contraction capabilities will be negatively affected
  • patients may present hypotensive
  • nitrates and morphine alone will dilate blood vessels worsening hypotension
  • under medical control direction patients are often treated with a fluid challenge with the nitrates
  • 1st degree heart block and secondary degree type 1 wenckebach most common heart blocks
  • fluids! to support preload
22
Q

complications of septal wall MI

A
  • lead V1 and V2
  • Significant amount of conduction components are in the septal area
  • Patient predisposed to dysrhythmia
  • Second degree Type II – classical
  • 3rd degree heart block
  • Bundle branch block
  • Lethal heart blocks treated aggressively - TCP
  • Rare to have a septal MI alone
  • Common to have anterior or lateral involvement along with septal area
23
Q

complications of anterior wall MI

A

-leads V3, V4
-Known as the “widowmaker” due to the potential for a massive area of infarction from blockage of the large amount of myocardium supplied by the LAD (left anterior descending artery)
-Often the septal or lateral walls are also involved
-Watch for lethal ventricular dysrhythmias and cardiogenic shock
-Second degree Type II and 3rd degree heart block are more common than other blocks
-Early death within a few days often from CHF
-Massive area of ventricular tissue infarcted if LAD totally occluded
-important to obtain history of recent MI
diagnosis and hospital discharge
-Increased incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) up to 1 -2 weeks post acute anterior M

24
Q

acute pulmonary edema

A
  • nitroglycerin given to dilate blood vessels and reduce preload
  • lasix given to dilate blood vessels and reduce preload -> as a diuretic
  • morphine given to dilate blood vessels and reduce preload -> reduce anxiety
25
Q

all medications and interventions (ex. CPAP) can drop the BP

A

-monitor carefully!

26
Q

cardiogenic shock

A
  • ineffective pumping from the damaged heart
  • IV fluid challenge if lung sounds are clear
  • dopamine drip titrated to maintain a systolic blood pressure of less than or equal to 100 mmHg
  • start at low dose (5mcg/kg/min)
  • estimate the patients pounds (ex. 100#)
  • take the 1st two numbers dropping the last number (ex. 10)
  • minus 2 from the 1st two numbers
  • this is the starting point for minidrips/minute (ex. 10-2 = 8)
27
Q

common terms to describe chest pain

A
  • heaviness
  • pressing
  • suffocating
  • squeezing
  • strangling
  • burning
  • constricting band
  • a weight in the center of my chest
  • a vise tightening around my chest
28
Q

patient complaints or presentations

A
  • Difficulty breathing
  • Excessive sweating
  • Unexplained nausea or vomiting
  • Generalized weakness
  • Dizziness
  • Syncope or near syncope
  • Palpitations
  • Isolated arm or jaw pain
  • Fatigue
  • Dysrhythmias
29
Q

atypical presentation in the elderly

A
  • most frequent symptoms of acute MI
  • shortness of breath
  • fatigue and weakness (i just dont feel well)
  • abdominal or epigastric discomfort
  • often have preexisting conditions making this an already vulnerable population:
  • hypertension
  • CHF
  • previous AMI
  • likely to delay seeking treatment
30
Q

atypical presentation in women

A
  • described as:
  • aching
  • tightness
  • pressure
  • sharpness
  • burning
  • fullness
  • tingling
  • frequent acute symptoms:
  • shortness of breath
  • weakness
  • unusual fatigue
  • cold sweats
  • dizziness
  • nausea/vomiting
  • often have no actual chest pain to offer as a complaint
  • often the pain is in the back, shoulders, or neck
31
Q

atypical presentation in patient with diabetes

A
  • atypical presentation due to autonomic dysfunction
  • common signs/symptoms:
  • generalized weakness
  • generalized feeling of not being well
  • syncope
  • lightheadedness
  • change in mental status
32
Q

region X SOP- acute coronary syndrome

A

-a 12 lead EKG is obtained on all patients presenting with signs and symptoms of acute MI

OR

-for patients where suspicions are raised that the patient may be experiencing an acute MI (ex. heart block)

33
Q

case 2

A

-inferior MI

34
Q

case 3

A
  • elevation in V1, V2, V3, V4
  • septal and anterior
  • anterioral septal wall MI
35
Q

case 4

A

-2, 3, aVF, V3, V4

36
Q

case 5

A
  • 2, 3, avF, V4

- inferior wall MI

37
Q

case 6

A
  • anterior septal wall MI

- V1, V2, V3, V4

38
Q

case 7

A

-no ST elevation

39
Q

case 8

A

-V2, V3, V1

40
Q

case 9

A
  • V3 is not positive
  • V4 might be positive
  • no MI
41
Q

case 10

A
  • 2, 3, aVF

- inferior wall MI

Cardiac Emergencies (13 decks)

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