12 leads

Question 1

8.5% of adults over 20 yrs have a cardiac ischemic diagnosis (T/f)

Answer 1

true

Question 2

what is PCI

Answer 2

percutaneous coronary Intervention, guide wire and a catheter is inserted through coronary arteries into the aorta and to the coronary arteries in the heart. Dye is injected to identify blockages. Then another catheter is inserted with a balloon which is then inflated. A stent is left in place to keep the vessels lumen open.

Question 3

when should a 12 lead be done?

Answer 3

10 mins after arrival when pt is experiencing infection, cp, sob, pneumonia, pneumothroax, etc.

Question 4

what is CAD?

Answer 4

when plaque build up occurs in the coronary arteries restricting blood flow—> MI

Question 5

RCA

Answer 5

right coronary artery branches off the base of the aorta and follows down the AV sulcus.
RCA splits intot he RMA and PDA

Question 6

RCA feeds….

Answer 6

right atria ( SA node), RV, & inferior wall of LV and feeds the AV node in most pt

Question 7

LCA

Answer 7

branches off the base of the aorta into 2 main arteries LAD and circumflex

Question 8

the LAD feeds

Answer 8

anterior & septal portions of the left & right ventricles

Question 9

Left circumflex feeds…

Answer 9

LA, lateral & posterior LV

Question 10

Coronary conduction disease:

Answer 10

when there is a delay in conduction between the AV node and the bundle of HIS due to faulty “atrial kick”

Question 11

normal length of Pr

Answer 11

0.12-0.20

Question 12

Normal qrs length

Answer 12

0.08s-0.12s

Question 13

V1

Answer 13

placed at the 4th ICS to the right of hte sternal boarder

Question 14

V2

Answer 14

4th ics left of sternum

Question 15

V3

Answer 15

half way between V2 and V4

Question 16

V4

Answer 16

5th ics midclavicular line

Question 17

V5

Answer 17

5th ICS anterior axillary line

Question 18

V6

Answer 18

mid axillary line level w v4-v5

Question 19

prep for ecg acquisition?

Answer 19

have hair, dry skin, keep pt still

Question 20

contiguous leads?

Answer 20

2 leads that look at the same areas of the heart at different angles.

Question 21

what are some contiguous leads?

Answer 21

Lead 2,3, avf look at the inferior portions of the heart in slightly different directions.

Question 22

goal of 12 lead?

Answer 22

STEMI Identification

Question 23

why does ischemia occur?

Answer 23

lack of O2 in cardiac tissue due to blockage

Question 24

what does ischemia look like on 12 lead?

Answer 24

St depression >1mm/or T wave inversion

Question 25

cardiac injury and how i looks on 12 lead?

Answer 25

due to prolonged ischemia ( MI). presents with hyperacute T-waves (early) that progresses to ST elevation, >2mm in leads 1-3 & >1mm in all other leads

Question 26

What is an infarct and what does the ecg look like?

Answer 26

death of cardiac tissue. Can have patho Q wave ( depth and wide >/=1mm or 25% of r wave amp & ST elevation.

Question 27

what is the gold standard for MI diagnosis?

Answer 27

angio (PCI)

Question 28

10% of the population left lateral wall of the heart is fed by the…..

Answer 28

circumflex

Question 29

What are your inferior leads? what does it show you?

Answer 29

Lead 2, 3 & aVF. shows inferioir portion of right ventricle and fed by RCA (PDA)

Question 30

If you have elevation in the inferior leads where can u expect to see reciprocal changes?

Answer 30

lateral leads: Lead 1, AvL, V5-v6

Question 31

RVI is contraindication for what drug use?

Answer 31

NTG bc RV is preload dependent

Question 32

What are the tell tale signs for RVI?

Answer 32

Bradycardia, hypotension, JVD, clear chest ascultations

Question 33

anterior leads? where would reciprocal changes be seen?

Answer 33

V4 & V3 views the anterior portion of LV supplied by LAD. Elevation in posterior leads(2,3, AVF) ( prompts 15 lead) –> posterior MI

Question 34

Septal leads and where reciprocal changes can be found.

Answer 34

V1 & V2 . reciprocal changes are in 1,2,AVF. (MI is usually anteriorseptal)

Question 35

Lateral leads and where are reciprocal changes?

Answer 35

fed by circumflex
high= Lead 1 & AvL
Low:V5 & V6–> shows ST elevation

reciprocal changes: lead 3 and AVF, Lead 2. Should show depression confirming lateral MI

Question 36

how would you Identify posterior wall MI?

Answer 36

St depression in anterior leads (V4, V3) and elevation in leads Inferior 2-3 & AvF and reciprocal changes in V4, V3. Need 15 lead (V7-V9 on back)

Question 37

when doing your interpretation what should you include?

Answer 37

location in heart ex: inferior wall MI what leads involved ex: due to elevation in leads 2, 3, avf. note what artery is occluded

Question 38

Mi TX:

Answer 38

titrate o2 >/=94
asa low dose
iv
ntg x 3 sprays max

Question 39

N-STEMI is an infarct of the…

Answer 39

endocardium, inside of the heart of the heart out
while a STEMI is the Outside of the heart in

Question 40

STEMI Bypass criteria

Answer 40

age: >/= 18 yrs
Other: onset </= 12hrs, CP or pain consistent with MI, 12 lead must indicate acute MI/STEMI
(at least >2mm in leads V1-V3 in at least 2 contiguous leads) or 1mm elevation in any other 2 anatomically contiguous leads, & the 12 lead interpretation and medic must agree.

Question 41

Other criteria for STEMI bypass?

Answer 41

• must not be CTAS 1, A?W must be secure, 12 lead must not have STEMI imitators, Transport to PIC <60 mins from contact, if pt is experiencing complication that PCP can manage:

Question 42

pt complications needing PCP management….

Answer 42

moderate to severe resp distress needing cpap, hemodynamic instability must be managed, must not be symptomatic SBP<90mmHG, VSA w rosc

Question 43

Pt complications needing acp diversion as follows….

Answer 43

inadequate vent despite asistance, hemodynamic instability unresponsive to care or VSA W no ROSC

Question 44

how would you determine RVI?

Answer 44

move leads V4-V6 on the right side of pt chest and label them on ECG w “r”. Identify if there is ST elevation in the leads= + STEMI