Advanced EKG Flashcards by Mary Munoz

Lead one negative lead placement

under R clavicle

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Lead one positive lead placement

under the L calvicle

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Lead two lead placement

Below L pectoral muscle= positive
R clavicle = negative lead

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Lead two positive lead placement

Below L pectoral muscle

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Lead of choice for electrical conversion

Lead 2

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Lead 3 electrode placement

L pectoral muscle = positive
negative lead = L clavicle

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MCL (V1) placement

negative = under L clavicle
positive= 4th intercostal space R sternal border

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12 lead ECG general placement for the leads

10 leads
one on each limb (4)
6 on the L chest.

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V1 placement

4th intercostal space, right of the sternum

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V2 placement

4th intercostal space, left of the sternum

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V3 Placement

Between V4 and V2

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V4 Placement

5th intercostal space, left of sternum- mid clavicular line

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V5 placement

5th intercostal space, left of sternum- anterior axillary line

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V6 placement

5th intercostal space, left of sternum- mid axillary line

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Characteristics of RSR’

start with upstroke, downstroke, upstroke
prime = second time to go about the isoelectric line

RSR’ typically seen in RBBB in MCL lead

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causes of L axis deviation

chronic htn
LV hypertrophy
aortic disease
extreme exercise

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causes of R axis deviations

Severe lung disease,
PE
pulmonary valve disease

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Pathologic L axis

(-40)-(-90)
+ lead 1, negative lead 2 and 3
Anterior hemiblock
disease process

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Physiologic L axis

0-(-40)
+ lead 1, positive or biphasic lead 2, negative lead 3
normal variant in some especially the obese and the athletic

Right axis deviation

90-180
negative lead 1, positive, negative or biphasic lead 2, postive lead 3
posterior hemiblock
Pathologic in all adults

Extreme right axis deviation

no mans land
1-3 leads are negative
ventricular origin

Determining R or L BBB what lead do you use?

MCL (V 1)
QRS complex must be at least .12sec ( (120 ms) or wider (or 3 little squares)
Arrow points up - turn signal up - Right BBB
Arrow points down - turn signal down - Left BBB

Normal heart axis

0-+90 degreees
leads 1-3 = +

Lidocaine and procainamide are contraindicated in what rhythm

intraventricular block

RCA myocardial blood supply

Inferior walls (LV) Posterior Wall (LV R Vent SA and AV node Posterior fascicle of LBB

RCA occlusions can cause what arrhythmia

Bradycardia

LAD blood supply

widow maker anterior wall of the LV Septal wall Bundle of his and BB

Circumflex blood supply

Lateral wall of LV SA and AV node Posterior wall of LV

AMI interventions

O2, NTG, Pain control ASA, heparin Thrombolytic prescreen Thrombolytic given

Contraindications for Thrombolytics

CV, ischemic stroke w/ thrombolytics (weakened bv), active bleeding, head injuries, uncontrolled htn relative; age, pregnancy, uncontrolled htn (>180/110), major sx in last 3 weeks.

Ischemia

Transient reduction in blood flow to the myocardium Symmetrical inverted T waves in 2 or more related leads

inverted T waves are normal in what leads?

leads 3 and V1

injury pattern

Injured yet salvageable ST segment elevation of more than 1mm in 2 or more related leads Most important thing to look for

ST depression

Reciprocal changes to other ST elevation Can indicate subendocardial injury Ischemia Drug or electrolyte problems (dig or hypokalemia)

Infarction

Death or Necrosis of Tissue Pathologic Q waves > 40 ms wide or 1/3 depth of r wave height When seen with ST elevation - AMI Q wave = full thickness (transmural)

Inferior location

RCA leads ; 2,3,avf recip; 1,AVL

Septal leads and blood supply

LAD leads V1,V2

Anterior Leads and blood supply

LAD leads; V3,V4 recip; 2,3,F

Lateral Leads and blood supply

circumflex leads; V5,V6, 1, L recip; 2,3,f

Posterior leads and blood supply

RCA leads; V8, V9 R>S in V1 recip; ST dep V1-4

Right Vent location

RCA leads V4R

Most commonly seen MI

Inferior MI

Inferior wall MI hemodynamics

bradycardia, hypotension 1st degree or second degree type 1 N/V

Most lethal MI

Anterior wall MI

Anterior wall MI caveats

can suddenly develop, CHB, VF or VT if seen with hemiblocks or BBB, place quick combo pads on the patient and prepare for the worst can extend to septum (anteroseptal) or lateral (anterolateral) nitrates are great, fluids are spared

Pericarditis

ST elevation in all leads Patient feels better when they lean forward Pericarditis will not have reciprocal ST depression

Dissecting Thoracic Aortic Aneurysm

Dangerous if misdiagnosed as an MI Heparin and NTG can be fatal Does not have reciprocal changes