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MDT > 12 Leads Part 2.1 > Flashcards

12 Leads Part 2.1 Flashcards

1
Q

ST elevation vs depression

A

Elevation: often indicates serious, acute injury (STEMI)
Depression: can suggest ischemia or injury but not necessarily a full infarction

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2
Q

In suspected cardiac ischemia cases, conduct multiple ECGS over time to track any changes. When should you take these ECGs?

A
  1. Conducted upon arrival at scene
  2. Done when patient is settled in the ambulance
  3. Upon arrival at the hospital once the truck has come to a stop
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3
Q

What does sensitivity and specificity mean?

A

Sensitivity: ability to recognize a true positive
Specificity: refers to the ability to avoid false positive

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4
Q

What is the J point

A

It marks the end of the QRS complex and beginning of the ST segment

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5
Q

Why shouldn’t you use the PR interval as a reference point for base line when trying to assess for a STEMI

A

This is because the PR interval can sometimes be depressed giving false indication that there’s a STEMI even though there is not

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6
Q

How should you measure ST elevation?

A
  • identify the J point
  • draw a line horizontal from the TP segment
  • measure how many milimeters the J point sits above base line
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7
Q

What are the causes for ST segment depression? (myocardial depression has some real life problems)

A
  • MI
  • Digoxin
  • Hypokalemia
  • SVT
  • RBBB
  • LBBB
  • Paced rhythms
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8
Q

ST depression can present in different forms. Horizontal, up-sloping, or down-sloping. Looking at this characteristic what rule of thumb can we use to infer that the ST depression is indicating towards Myocardial ischemia?

A
  • horizontal or down sloping ST depression
  • if J point is below base line by more than 0.5mm in two or more leads
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9
Q

What are reciprocal leads?

A

These are changes that occur when one lead shows ST elevation and the leads the look at the opposite angle from the heart shows ST depression

*this patter is an important diagnostic sign of a STEMI

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10
Q

What is forced perspective photography and its application to ECG leads?

A

The distance and position of the lead is correlated to the amount of ST elevation seen
- limb leads are further from the heart and require less elevation to be considered significant
- Precordial leads are closer to the heart so mor elevation is needed to be considered more significant

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11
Q

What are contiguous lead?

A

Leads that look at the same region of the heart

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12
Q

What is significant ST elevation in leads V2 and V3 for Patients who carry XY chromosomes?

A

<40 YOA = 2.5mm of elevation
>40 YOA - 2.0mm of elevation

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13
Q

What is significant ST elevation in patients who carry XX chromosomes in leads V2 and V3?

A

1.5mm of elevation

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14
Q

Which leads assess the circumflex?

A

1, aVL, V5, and V6 (high lateral and low lateral leads)

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15
Q

Which leads assess the RCA?

A

2,3, and aVF (inferior leads)

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16
Q

Which leads assess the LAD

A

V1 - V4 (septal and anterior leads)

17
Q

What leads will show ST elevation for an extensive anterior STEMI?

A

V1-V6

18
Q

Take time to explain which leads pertain to which types of MIs

A

Septal : V1 and V2
Anterior : V3 and V4
Lateral : V5 and V6
Anteroseptal : V1 - V4
Anterolateral : V3 - V6
Extensive anterior V1 - V6
Inferior : leads 2 and 3 and aVF
High lateral : lead 1 and aVL

19
Q

Do reciprocal changes confirm STEMI?

A

No, they are not required to diagnose STEMI but serve as additional evidence supporting the diagnosis

20
Q

When should you consider a 15 lead?

A
  • When you see ST depression in V1-V4 because this is the reciprocal view that indicates a posterior MI
  • when you see signs of inferior MI (leads 2,3 and aVF) to assess for right ventricular involvement
21
Q

When leads 1 and aVL have ST elevation this includes; anterolateral,lateralSTEMI’s. What is the reciprocal leads?

A

2, 3 , and aVF. This is vice versa for elevation in these leads during a inferior STEMMI

22
Q

If ST elevation in lead 3 is greater than that of lead 2. What does this likely indicate?

A

Indicative of a RCA occlusion

23
Q

If lead 2 is greater in elevation than that of lead 3 what does this indicate?

A

May suggest lateral wall involvement due to CFLX artery

24
Q

Why do inferior MIs sometimes cause bradycardia and AV blocks?

A

This is du to the proximity of the AV node and their coronary artery supply

MDT (20 decks)

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