Axis Determination And Acute Coronary Syndrome (ACS) NSTEMI/STEMI

Question 1

Limb Leads

Answer 1

Depolarization of the heart in frontal or coronal plane

Question 2

PRECORDIAL leads

Answer 2

Depolarization of the heart at transverse plane

Question 3

Cameras on the EKG , waves up from base line and waves down from base line

Answer 3

Up from base line = going towards the camera

Down from baseline wave = going away from camera

Question 4

Normal axis

Answer 4

Between 0 degrees and +90 degrees

Question 5

percent of AMI that is painless

Answer 5

20%

Question 6

evolution of MI

5 steps

Answer 6

1. healthy heart
2. plaque with fibrous cap
3. Cap ruptures or erodes : exposed platelet recruiting factors
4. Blood clot forms = blocks artery
5. heart myocardium dies at that location

Question 7

NSTEMI

Answer 7

partially blocked vessel
NO ST elevation
t wave peaking or inversion
Deep q- wave
*with no increase in Troponin
*old MI usually

Question 8

STEMI

Answer 8

completely blocked vessel
ST elevation
or is no ST elevation there is elevation in Troponin

Question 9

Prinzmetal Angina

Answer 9

MI from vasospasm occurring

Question 10

Myocardium is dying seen on

Answer 10

elevated ST

Question 11

Myocardium is ischemic is seen on

Answer 11

depressed ST, inverted or tall T waves

Question 12

dead myocardium is seen on

Answer 12

Deep Q wave

Question 13

false + in high Troponin can be seen in which patients

Answer 13

Renal Failure

Question 14

when can you conclude a j-point to conclude a STEMI

Answer 14

1. ST elevation is 2mm* 1.5mm in women (2 small boxes) at least in V2 +V3
2. ST elevation more then 2 (or 1.5mm) in 2 or more same category leads

Question 15

evolution of MI on the ECG*

Answer 15

1. normal waves + inverted t-wave
2. elevated ST (J-point) + inverted t-wave
3. ST elevation decreases, Q-wave deep + inverted T
4. ST normal, Deep Q wave + inverted T-wave
5. ST normal, deep Q, short R, normal T (DEAD)

Question 16

AV block is what

Answer 16

SA node not firing right to the AV node, or something up with AV node passing the impulse

Question 17

HEART SUPPLY + LEADS:

1. anterior
2. lateral
3. inferior
4. posterior

Answer 17

1. LAD (left ant descending) : V1-V6
2. Circumflex a (left) : 1, AVL, V5,V6
3. Right main coronary a : 2,3, AVF
4. Posterior descending a : V1-V3 * 20% from RV atrophy from inferior (RCA) + circumflex A

Question 18

old MI in inferior heart

Answer 18

deep Q wave in lead 2,3,AVF

Question 19

old MI anterior heart

Answer 19

deep Q wave lead V2-V4

Question 20

Acute anterior lateral heart MI

Answer 20

elevated ST lead 1, AVL, V5,V6, V2-V4

Question 21

posterior heart MI (old or acute?)

Answer 21

flip the ECG
LEAD V1, high prominent R wave —-> deep Q wave + elevated ST
=STEMI

Question 22

widow blockage

Answer 22

LAD is occluded at the proximal end also occluding circumflex and = huge part of heart is effected

Question 23

Ectopic beats

Answer 23

PAC or PVC

Question 24

PAC

Answer 24

one P wave doesn’t look like the others, causing a QRS earlier then it should
*from ectopic foci in right atrium

Question 25

PVC

Answer 25

the QRS looks different depending on where the ectopic foci is sending impulse from in the ventricle (tip, lateral wall, medial wall)
*there are different names depending on how often

Question 26

V tachy

Answer 26

wide QRS complexes and very fast, no p wave seen

all foci are in one location of ventricle

Question 27

Supraventricular Tachy

Answer 27

fast HR, normal looking QRS, no p wave shown

TX: throw ice cold water, rub carotid a, adencord = vagal maneuver

Question 28

A fib

Answer 28

can cause blood pooling and blood clot in atrium

no p wave, IRREGULAR heart beat

Question 29

AV block 1st degree

Answer 29

PR interval is longer then 1 big box (0.2sec)

Regular HR

Question 30

AV block 2nd degree

Answer 30

Type 1 : WENCKEBACH = each PR interval gets longer and longer until one QRS is dropped
Type 2 : each PR interval is the same length (and prolonged) and randomly one QRS is dropped

Question 31

AV block 3rd degree

Answer 31

A and V have their own HR not connected (AV disconnection)
A doesn’t pass signal to V so V has to make its own HR usually slower
* more p waves then QRS waves, P wave HR is faster)