advanced ekg Flashcards by Mebin k

hyperkalemia can turn into what waves

sine

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QRS complex:
QRS widening
fusion of QRS-T
loss of the ST segment

hyperkalemia

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ST depression and flattening of the T wave

Negative T waves

A U-wave may be visible

hypokalemia

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P-waves are widened and of low amplitude due to slowing of conduction

hyperkalemia

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Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.

hypercalcemia

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hypercalcemia causes

tumor lysis in cancer

stimulation from PTH periop
(get baseline/ postop labs)

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hypocalcemia

Narrowing of the QRS complex

Reduced PR interval

T wave flattening and inversion

Prolongation of the QT-interval

Prominent U-wave

Prolonged ST and ST-depression

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most commonly associated with hypothermia, may also occur in hypercalcemia.

osborn J wave

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changes will appear as a reciprocal, negative deflection in aVR and V1.

osborn J wave

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causes of delta wave

WPW and abherrnat pathway

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a slurred upstroke in the QRS complex. It relates to pre-excitation of the ventricles, and therefore often causes an associated shortening of the PR interval

delta wave

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cautious with what two drugs with delta wave

adenosine and CCBs

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Lead I is therefore an ___ tracing.

Lead 1 good for looking at?

Lead I is therefore an upright tracing.

Lead 1 for atria

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lead III is better for looking at?

ventricles

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Lead II is also the recommended lead of choice for

Lead II is also the recommended lead of choice for electrical cardioversion.

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12 lead views from 10 electrodes why?

augmented leads

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Note that in lead III the baseline wanders up and down. This is due to

due to the positive electrode being located on the diaphragm.

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how to improve lead placement

Supine position is recommended

Clip or shave chest hair if necessary

Wipe diaphoretic skin with a towel

Consider using benzene, alcohol, betadine

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Shoulders do NOT count

Shoulders do NOT count as limbs!

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4th intercostal space, right of sternum

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4th intercostal space, left of the sternum

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between V4 and V2

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5th intercostal space, the mid-clavicular line.

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5th intercostal space, anterior axillary line

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5th intercostal space, the mid-axillary line

first negative deflection after P wave in any lead

Q wave

first positive deflection after P wave in any lead

R wave

negative deflection below the baseline after an R or Q wave

s wave

where the qrs complex ends and ST segment begins

J point

An RSR prime complex is a classic pattern for

a right bundle branch block in lead MCL1

The R prime wave represents

the second time the complex goes above the isoelectric line.

The J point is important for two reasons

One, it is the point of reference for determining bundle branch blocks; and two, it is the point of reference for measuring the ST segment elevation.

lead I upright lead II down lead III down

pathological left axis

lead I down lead II down lead III down

extreme right axis ventricular in origin prolly Vtach

lead I down lead II indeterminate lead III upright

right axis

Point out that a left bundle branch block ______ a right bundle branch block because _______

Point out that a left bundle branch block is worse than a right bundle branch block because it involves two out of three fascicles.

Also mention that you do not look for ST segment elevation in the presence _____ due to ______

the presence of a left bundle branch block due to the late repolarization of the left ventricle distorting the ST segment.

drugs such as Lidocaine and Procainamide are contraindicated.

bifasicular blocks

RCA supply

Inferior Wall (LV) Posterior Wall (LV) Right Ventricle SA and AV Node Posterior fascicle of LBB

Left anterior descending LAD supply

“Widow Maker” Anterior Wall of LV Septal Wall Bundle of His and BB

Circumflex supply

Circumflex Lateral Wall of LV SA and AV nodes Posterior Wall of LV

Chest Pain on Exertion = Chest Pain at Rest = Chest pain unrelieved by nitroglycerin =

Chest Pain on Exertion = 70 - 85% occlusion Chest Pain at Rest = 90% occlusion Chest pain unrelieved by nitroglycerin = 100% occlusion

heparin and ASA dosage for acute MI

5000 units 325mg

A normal 12 lead doesnt rule out?

An MI

Symmetrical inverted T waves in 2 or more related leads

Ischemia

Can cause__ transiently with induction

ischemia

ST segment elevation of more than 1mm in 2 or more related leads

injury pattern

In the absence of ST elevation, then ST depression generally means

ischemia or subendocardial injury

inferior RCA infarct what leads

II, III, F recip: I, aVL

septal LAD infarct what leads

V1, V2

anterior LAD infarct what leads

V3, V4 recip: II, III, aVF

lateral CIRC infarct what leads

V5, V6, I, aVL recip: II, III, aVF

posterior RCA infarct what leads?

V8, V9

Right vent RCA infarct what leads

V4R

Pathologic Q waves > 40 ms wide or 1/3 depth of r wave height

infarction

Point out that 50% of the time an inferior has___, and 30% of the time the _______

Point out that 50% of the time an inferior has posterior involvement, and 30% of the time the right ventricle is involved

Clinical signs of a right ventricular infarction include

include hypotension, JVD, and clear lung sounds

Patients may have bradycardia and hypotension Could also have 1st degree or Mobitz 1 blocks what infarct?

inferior MI

Most common seen. Can be fatal Nausea is common, antiemetics Use nitrates with caution, may need fluids what infarct?

inferior MI

most lethal (highest mortality) can suddenly develop, CHB, VF or VT

anterior wall MI

this MI can extend to septum or lateral nitrates are great, fluids are spared

anterior wall MI

if seen with hemiblocks or BBB, place quick combo pads on the patient and prepare for the worst what MI?

anterior MI

Patient feels better when they lean forward will not have reciprocal ST depression

pericarditis

This condition can have ST segment elevation, however it will not have reciprocal changes

Dissecting Thoracic Aortic Aneurysm

Heparin could prove fatal if given to this patient. Nitroglycerin is given with caution, if at all, due to the heart’s attempt to compensate for decreased afterload by increasing heart rate and contractility. This would cause undue stress on a weakened area of the aorta.

Dissecting Thoracic Aortic Aneurysm