Advanced EKG Flashcards
Lead one negative lead placement
under R clavicle
Lead one positive lead placement
under the L calvicle
Lead two lead placement
Below L pectoral muscle= positive
R clavicle = negative lead
Lead two positive lead placement
Below L pectoral muscle
Lead of choice for electrical conversion
Lead 2
Lead 3 electrode placement
L pectoral muscle = positive
negative lead = L clavicle
MCL (V1) placement
negative = under L clavicle
positive= 4th intercostal space R sternal border
12 lead ECG general placement for the leads
10 leads
one on each limb (4)
6 on the L chest.
V1 placement
4th intercostal space, right of the sternum
V2 placement
4th intercostal space, left of the sternum
V3 Placement
Between V4 and V2
V4 Placement
5th intercostal space, left of sternum- mid clavicular line
V5 placement
5th intercostal space, left of sternum- anterior axillary line
V6 placement
5th intercostal space, left of sternum- mid axillary line
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
causes of L axis deviation
chronic htn
LV hypertrophy
aortic disease
extreme exercise
causes of R axis deviations
Severe lung disease,
PE
pulmonary valve disease
Pathologic L axis
(-40)-(-90)
+ lead 1, negative lead 2 and 3
Anterior hemiblock
disease process
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
