12 leads continued Flashcards
what is a bundle branch block?
a delay in cardiac conduction where one ventricle depolarizes faster than the other due to left or right block or both being blocked.
what are the risks of BBB?
decreased CO due to decreased pumpefficency, reduced tissue o2 if LBBB
which BB is most common?
Rbbb
why are RBBB not as significant?
Right side delivers deoxy blood (pulmonary circuit) to lungs while L –> systemically(widespread & fast tissue deoxygenation.
what leads are we looking at to diagnose a RBB?
V1 & V6 for , SLUR in s wave
how is an LBBB identified?
wide QRS, deep swave in V1, & negative qrs deflection with disconcordant Twave in V2 & notche din RsR in V6-V5
Which BBB is a STEMI Mimic?
LBBB
What are some other STEMI mimics?
HTN, myocarditis, Left ventricular hypertrophy, HF, valvular disease.
What is the 2nd highest indicator for STEMI according to Sgarbossa’s?
ST depression >/= 1mm in leads V1,V2 or/& V3= 3 points
How are STEMI identified w LBBB?
Sgarbossa’s criteria
What is the highest indicator for STEMI with LBBB according to Sgarbossa’s?
ST elevation>/= 1mm in leads with + QRS ( V4-V6, aVL, 1)= 5 points
what is the lowest indicator for STEMI w LBB according to sgarbossa’s?
ST elevation >/= 5mm in any leads w disconcordant qrs (V1-V3)
which artery supplies the lateral left ventricle?
circumflex
What causes an anterolateral wall IM?
occlusion of the LCA before it bifurcates into the LAD and the circumflex
which artery supplies the inferior wall of the left ventricle in most people?
RCA in 10% of the population the LV if fed by the circumflex
Which artery supplies the anterior or anteroseptal wall of the left ventricle?
Left anterior descending artery (LAD)
Inferior wall MI usually shows ST depression in what leads? what leads show elevation?
V1 & V2/ elevation in leads 1-3.
in a 15 lead acquisition where should leads V7-V9 be put?
straught line across the back with V7 at posterior axillary line, V8= straight line w midscapular line, V9 aligned at left vertebral border
if you suspect a posterior wall IM what should you to confirm it?
15 lead with posterior leads to confirm.
what does a patho q wave look like and tell you?
deep and wide Q wave longer than 25% of the r wave amplitude. Tells you that the heart tissue is necrotic.
what does a deep & inverted Twave tell you?
ischemia
what does ST elevation tell you?
cardiac cell injury
