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Cardiology > 9) 15 lead & MI > Flashcards

9) 15 lead & MI Flashcards

1
Q

aVR:
Lead Sensitivity & Specificity:

A

augmented voltage right} HUGE!!!
= Sensitivity 80% & Specificity 95%

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2
Q

Nitro) Women typically take boner pills for :
Other reasons for taking Boner pills:
Boner pills name & Common prescribed:

A

= Pulmonary hypertension
= Hypertrophic prostate problems
= phosphodiesterase-5 (PDE5) inhibitors} sildenafil (Viagra) and tadalafil (Cialis)

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3
Q

Right inferior wall MI:
STEMI produced w/ MIs:
OMI:
RIGHT VENTRICULAR INFARCT (RVI):

A

= most common MI up to 50% w/ RVI & 5-6% only RVI
= 50% MIs
= occlusion MI in coronary arteries
= Isolated RVIs don’t occur to frequent

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4
Q

ECG change represents active myocardial injury:

A

ST-Segment Elevation

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5
Q

Sides of heart w/ MI dif/s

A

= Rs-heart < M. so drowns w/ MIs & L-side can still pump bc more M.

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6
Q

Coronary Artery Occlusion Data) CP w/ exertion % narrowing:
Chest Pain at rest have % occlusion:
Chest Pain not relieved by nitro % occlusion:

A

= 70-85% narrowing
= 90% occlusion
= 100% occlusion w/ clot!!

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7
Q

Which of the following ECG changes represents myocardial ischemia:

A

Hyperacute T-Waves

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8
Q

Blue dots:

A

= (electrode) have 5 lil dots for abrading skin, run finger around white NEVER BLUE PART

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9
Q

15 lead) Skin prep: dry wet skin, shave/clip, Gently abrade dead skin (skin prep tape) 3m red dot skin sandpaper
MCL:

A

= dry wet skin, shave/clip, Gently abrade dead skin (skin prep tape) 3m red dot skin sandpaper
= MCL “12 lead w/o 12lead cables”

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10
Q

1 Multi-Lead ECG (9-Lead) Monitor’s ECG:

2 Auto-trending:
3 Auto-trending prints outside timeframe if:
4 Non diagnostic:
5 Setting Changes for diagnostic:
6 Intervals:

A

= “Just know where + is for views” Standard 12 lead: 1,2,3 then aVR, aVL, AVF then V1,2,3 then V4,5,6
= Computer Pulls best 2.5 secs for each lead from 9-10secs
= computer will spit out paper when keeping 12 lead on
= ** STEMI or Bisificular block ** ~95-96%
= clean 12 lead}Age important (F or M) ESPECIALLY PEDIS
= PR & QRS usually well, QT: calc >0.45 long, P-QRS-T Axes 50

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11
Q

Standard hospital printout:

A

All boxes w/ 3 static strips, 6 sec strip 4 lead 2.5 sec 12 lead

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12
Q

Isoelectric line:
Used for:

A

= Down 1mV of calibration bar/ line (bottom of cal)
= ST seg depress/elevation, Hypertrophy, amplitude

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13
Q

Congitual:
Reciprocal changes:
Spodicks sign:

A

= same view leads
= mirrored effect in oppisute/corresponding leads for sure MI
= pericarditis PR slopes down aka STEMI imposter

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14
Q

1 cause of death when having a MI

A

is from a lethal dysarrhythmia

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15
Q

Lvls of infarction:
Sub-Endo damage:
Transmural damage:
Infarct damage:

A

= Endo, transmural, infarct/ Ischemia Injury Infarct
= (Ischemia) Inside wall damaged 1st endocarditis
= (Injury) In-outside hypoxia 50% damage
= (Infarction) all death

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16
Q

ECG changes represents an old myocardial infarct:

A

Pathological Q-Waves “Yesterday’s news”

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17
Q

FMC

A

First Medical Contact “see STEMI call it in then”

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18
Q

Sub-Endo damage
Transmural damage

A

= damage just inside
= like burn full damage

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19
Q

In setting of ACS) + STE in aVL:
+ STE in V1:
STE in aVR > STE V1:
STE in aVR > 1.0mm

A

= LMCA occlusion
= LMCA or proximal LAD occlusion
= LMCA occlusion
= should make you worry!!

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20
Q

AMI Recognition) What to look for
mm criteria in leads
V2 & V3 female criteria:
V2 & V3 <40 Males criteria:
V2 & V3 >40 Males criteria:

A

= ST seg/ elevation Present in 2 anatomically contiguous leads
= 1mm or > in all leads except V2 & V3
= 1.5 mm or > for females
= 2.5 mm or more for males <40 years of age
= 2 mm or more for males >40 years of age

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21
Q

!!!aVR–The Forgotten Lead:
Possible ischemic findings:

STE in aVR > STE V1:
STE in aVR > 1.0mm should make you worry!!

A

= ST-seg elevation (STE) w/ other ischemic findings is BAD!!!
=Widow-maker, LMCA occlusion, proximal LAD occlusion, or triple vessel disease
= LMCA occlusion
= should make you worry!!

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22
Q

Widow-maker:
w/ PVC in 4 lead:
Inferior MIs expect:

A

= Full left side infarction from left coronary arteries infarction
= “PVCs put em leads”
= heart blocks & bradycardias (SA & AV aint des)

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23
Q

Lead Sensitivity:
Lead Specificity:

A

= how often shows up
= how accurate

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24
Q

Nitro notes) nitro max admin & before narc:
RS no nitro b/c:
Inferior MIs contraindicate Nitro:

A

= 3 nitros before giving narc
= RS Preload dependent (frank starling)
= often involve (RCA) supplies blood to (RV) for preload dependency & nitro admin will tank BP

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25
Q

15 lead) switching leads to back & R:
Leads V1-6:
If poor progression:
Monitor & diagnostic modes:
Determining Diagnostic:

A

= P wave, QRS, T upside-down lead 1
= upright R wave progression increasing amplitude
= check placement
= Monitor conjoins readings & diagnostic fine line reading
= 1-30Hz in bottom

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26
Q

ST seg) J point for measuring ST:
1sb/mm elevation or depression:
Measure J point:
in short w/ measuring:

A

= J point for measuring ST (start S end T)
= STE & ischemic Damage
= Measure against TP seg
= Below TP depression above TP elevation

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27
Q

Wellens sign:

A

biphasic T wave 50% of people not STEMI but having MI

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28
Q

Reciprocal leads:

A
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29
Q

Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view

A

= Anterior
= Septal
= Inferior
= Lateral

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30
Q

Leads V1 and V2 look at what part of the heart?

A

Septal (blockages from LAD commonly)

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31
Q

Leads 1, aVL, V5, V6 look at what part of heart:

A

L-Lateral (low view : views LCX & LAD)

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32
Q

Leads V3 and V4 look at what part of the heart?

A

L-Anteriorwall (LAD & LMCA blocks)

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33
Q

Leads II, III and aVF look at what part of the heart?

A

Inferior wall (most common blockacke(RCA)

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34
Q

Which coronary artery feeds the inferior wall of the heart?

A

Right Coronary Artery (RCA)

35
Q

Which coronary artery feeds the left lateral wall of the heart?

A

Left Circumflex (LCX)

36
Q

A blockage of which of the following would result in the entire left ventricle not receiving blood supply?

A

Left Main Coronary Artery (LMCA)

37
Q

(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:

A

= <5mm in LL
= <10mm in precordial

38
Q

1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:

A

1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks

39
Q

Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view

A

= Anterior
= Septal
= Inferior
= Lateral

40
Q

Leads V1 and V2 look at what part of the heart?

A

Septal (blockages from LAD commonly)

41
Q

Leads 1, aVL, V5, V6 look at what part of heart:

A

L-Lateral (low view : views LCX & LAD)

42
Q

Leads V3 and V4 look at what part of the heart?

A

L-Anteriorwall (LAD & LMCA blocks)

43
Q

Leads II, III and aVF look at what part of the heart?

A

Inferior wall (most common blockacke(RCA)

44
Q

A Lateral Wall high view:
B Left Lateral low view:
C Inferior wall view:
D Septal wall view:
E L-Anterior view:

A

A= Lead I & aVL= LA
B= Lead 1, aVL, V5 & V6: views LCX & LAD
C= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
D= V1 & V2: Along sternal borders blockages from LAD commonly
E= V3 & V4: left anterior wall : LAD & LMCA blocks

45
Q

V8 & V9 STEMI criteria:

A

0.5mm or greater

46
Q

3 I’S of cardiac) ST depression, Hyperacute or flipped T Wave:

A

Ischemia

47
Q

15 leads views) Lead I
Lead II
Lead III

A

Lead I Lateral
Lead II & 3 Inferior

48
Q

15 leads views) Lead aVR
Lead aVL
Lead aVF

A

Lead aVR 4 vessel
Lead aVL Lateral
Lead aVF inferior

49
Q

3 I’S of cardiac) ST Elevation:

A

Injury

50
Q

15 leads views) Lead V4-6

A

Lead V4 Anterior
Lead V5-6 Lateral

51
Q

15 leads views) Lead V4R
Lead V8-9

A

Lead V4R Right
Lead V8-9 Posterior

52
Q

3 I’S of cardiac) Pathologic Q

A

Infarction

53
Q

12/15 Lead ECG Kev Approach) 1st.
2nd.

3rd.
4th.

5th.
6th.

7th.

8th

A

1st} Is there a clear isoelectric baseline? (Skin prep correctly)
2nd} Are QRSs upright leads I, II & III (Check attachment correctly)
3rd} good R wave progression? (Check lead placement)
4th} Is the monitor in the correct mode(diagnostic)? (0.05 to either 40 or 150 Hz)
5th} Is the axis normal? Any axis deviation present?
6th} Is there any ST elevation present? If yes, do you see it in 2 or more contiguous leads?
7th} Is there any ST depression? If yes, do you see it in 2 or
more contiguous leads?
8th} any pathological Q waves present? Yesterday’s news!

54
Q

Precordial Posterior Lead Placement) V8(5)
V9(6):

A

= Mid-Scapular
= ½ way in-between the Scapula & Spine

55
Q

STE leads criteria) Lead I-III

A

≥ 1mm

56
Q

STE leads criteria) Lead aVR, aVL, aVF

A

≥ 1mm

57
Q

STE leads criteria) Lead V1
Lead V2-3

A

Lead V1 ≥ 1mm
Lead V2-3}≥ 2mm M>40, 2.5mm M<40 1.5 all women

58
Q

STE leads criteria) Lead V4-6

A

≥ 1mm

59
Q

STE leads criteria) Lead V4R
Lead V8-9

A

Lead V4R ≥ 1mm
Lead V8-9 ≥ 0.5mm

60
Q

ECG Camera views) Right

A

Lead V4R

61
Q

ECG Camera views) Left Lateral

A

Lead I, aVL, V4, V5

62
Q

ECG Camera views) Septal

A

Lead V1 V2

63
Q

ECG Camera views) Anterior

A

Lead V3 V4

64
Q

ECG Camera views) Posterior

A

Lead V5 V6

65
Q

ECG Camera views) LMCA - 3 vessel disease

A

Lead aVR

66
Q

ECG Lead views) Lead aVR

A

LMCA - 3 vessel disease

67
Q

ECG Lead views) Lead V5 V6

A

Posterior

68
Q

ECG Lead views) Lead V3 V4

A

Anterior

69
Q

ECG Lead views) Lead V1 V2

A

Septal

70
Q

ECG Lead views) Lead I, aVL, V4, V5

A

Left Lateral

71
Q

ECG Lead views) Lead V4R

A

Right

72
Q

ECG Lead coronary arteries) Anterior

A

(LAD) Left Anterior Descending

73
Q

ECG Lead coronary arteries) Inferior

A

(RCA) Right Coronary Artery

74
Q

ECG Lead coronary arteries) Posterior

A

(RCA) Right Coronary Artery &/or (LCX)

75
Q

ECG Lead coronary arteries) Right

A

(RCA)

76
Q

ECG Lead coronary arteries) Lateral

A

(LCX) Left Circumflex

77
Q

Coronary) Coronary artery feeds the inferior wall of the heart?

A

Right Coronary Artery (RCA)

78
Q

Coronary)coronary artery feeds the left lateral wall of the heart?

A

Left Circumflex (LCX)

79
Q

Coronary) blockage of what CA would result in the entire L-ventricle not receiving blood supply?

A

Left Main Coronary Artery (LMCA)

80
Q

Coronary) left coronary artery supplies:

Left coronary artery 2 major branches are:

A

= L-ventricle, Intraventricular septum, part of R-ventricle & lower conductive system
= anterior descending artery and the circumflex artery

81
Q

Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:

A

= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery

82
Q

Coronary) coronary vessels A&P

A

coronary vessels receive blood during diastole when the heart relaxes b/c aortic valve leaflets cover the coronary artery openings (ostia) during systole.

83
Q

Leads 2, 3, aVF reciprocal leads

A

leads 1, aVL, V1-6

84
Q

Leads 1, aVL, V1-6 reciprocal leads

A

2, 3, aVF reciprocal leads

Cardiology (20 decks)

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