12 leads continued

Question 1

what is a bundle branch block?

Answer 1

a delay in cardiac conduction where one ventricle depolarizes faster than the other due to left or right block or both being blocked.

Question 2

what are the risks of BBB?

Answer 2

decreased CO due to decreased pumpefficency, reduced tissue o2 if LBBB

Question 3

which BB is most common?

Answer 3

Rbbb

Question 4

why are RBBB not as significant?

Answer 4

Right side delivers deoxy blood (pulmonary circuit) to lungs while L –> systemically(widespread & fast tissue deoxygenation.

Question 5

what leads are we looking at to diagnose a RBB?

Answer 5

V1 & V6 for , SLUR in s wave

Question 6

how is an LBBB identified?

Answer 6

wide QRS, deep swave in V1, & negative qrs deflection with disconcordant Twave in V2 & notche din RsR in V6-V5

Question 7

Which BBB is a STEMI Mimic?

Answer 7

LBBB

Question 8

What are some other STEMI mimics?

Answer 8

HTN, myocarditis, Left ventricular hypertrophy, HF, valvular disease.

Question 9

What is the 2nd highest indicator for STEMI according to Sgarbossa’s?

Answer 9

ST depression >/= 1mm in leads V1,V2 or/& V3= 3 points

Question 9

How are STEMI identified w LBBB?

Answer 9

Sgarbossa’s criteria

Question 10

What is the highest indicator for STEMI with LBBB according to Sgarbossa’s?

Answer 10

ST elevation>/= 1mm in leads with + QRS ( V4-V6, aVL, 1)= 5 points

Question 11

what is the lowest indicator for STEMI w LBB according to sgarbossa’s?

Answer 11

ST elevation >/= 5mm in any leads w disconcordant qrs (V1-V3)

Question 12

which artery supplies the lateral left ventricle?

Answer 12

circumflex

Question 13

What causes an anterolateral wall IM?

Answer 13

occlusion of the LCA before it bifurcates into the LAD and the circumflex

Question 14

which artery supplies the inferior wall of the left ventricle in most people?

Answer 14

RCA in 10% of the population the LV if fed by the circumflex

Question 15

Which artery supplies the anterior or anteroseptal wall of the left ventricle?

Answer 15

Left anterior descending artery (LAD)

Question 16

Inferior wall MI usually shows ST depression in what leads? what leads show elevation?

Answer 16

V1 & V2/ elevation in leads 1-3.

Question 17

in a 15 lead acquisition where should leads V7-V9 be put?

Answer 17

straught line across the back with V7 at posterior axillary line, V8= straight line w midscapular line, V9 aligned at left vertebral border

Question 18

if you suspect a posterior wall IM what should you to confirm it?

Answer 18

15 lead with posterior leads to confirm.

Question 19

what does a patho q wave look like and tell you?

Answer 19

deep and wide Q wave longer than 25% of the r wave amplitude. Tells you that the heart tissue is necrotic.

Question 20

what does a deep & inverted Twave tell you?

Answer 20

ischemia

Question 21

what does ST elevation tell you?

Answer 21

cardiac cell injury