Axis Determination And Acute Coronary Syndrome (ACS) NSTEMI/STEMI Flashcards
Limb Leads
Depolarization of the heart in frontal or coronal plane
PRECORDIAL leads
Depolarization of the heart at transverse plane
Cameras on the EKG , waves up from base line and waves down from base line
Up from base line = going towards the camera
Down from baseline wave = going away from camera
Normal axis
Between 0 degrees and +90 degrees
percent of AMI that is painless
20%
evolution of MI
5 steps
- healthy heart
- plaque with fibrous cap
- Cap ruptures or erodes : exposed platelet recruiting factors
- Blood clot forms = blocks artery
- heart myocardium dies at that location
NSTEMI
partially blocked vessel NO ST elevation t wave peaking or inversion Deep q- wave *with no increase in Troponin *old MI usually
STEMI
completely blocked vessel
ST elevation
or is no ST elevation there is elevation in Troponin
Prinzmetal Angina
MI from vasospasm occurring
Myocardium is dying seen on
elevated ST
Myocardium is ischemic is seen on
depressed ST, inverted or tall T waves
dead myocardium is seen on
Deep Q wave
false + in high Troponin can be seen in which patients
Renal Failure
when can you conclude a j-point to conclude a STEMI
- ST elevation is 2mm* 1.5mm in women (2 small boxes) at least in V2 +V3
- ST elevation more then 2 (or 1.5mm) in 2 or more same category leads
evolution of MI on the ECG*
- normal waves + inverted t-wave
- elevated ST (J-point) + inverted t-wave
- ST elevation decreases, Q-wave deep + inverted T
- ST normal, Deep Q wave + inverted T-wave
- ST normal, deep Q, short R, normal T (DEAD)
AV block is what
SA node not firing right to the AV node, or something up with AV node passing the impulse
HEART SUPPLY + LEADS:
- anterior
- lateral
- inferior
- posterior
- LAD (left ant descending) : V1-V6
- Circumflex a (left) : 1, AVL, V5,V6
- Right main coronary a : 2,3, AVF
- Posterior descending a : V1-V3 * 20% from RV atrophy from inferior (RCA) + circumflex A
old MI in inferior heart
deep Q wave in lead 2,3,AVF
old MI anterior heart
deep Q wave lead V2-V4
Acute anterior lateral heart MI
elevated ST lead 1, AVL, V5,V6, V2-V4
posterior heart MI (old or acute?)
flip the ECG
LEAD V1, high prominent R wave —-> deep Q wave + elevated ST
=STEMI
widow blockage
LAD is occluded at the proximal end also occluding circumflex and = huge part of heart is effected
Ectopic beats
PAC or PVC
PAC
one P wave doesn’t look like the others, causing a QRS earlier then it should
*from ectopic foci in right atrium
PVC
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
V tachy
wide QRS complexes and very fast, no p wave seen
all foci are in one location of ventricle
Supraventricular Tachy
fast HR, normal looking QRS, no p wave shown
TX: throw ice cold water, rub carotid a, adencord = vagal maneuver
A fib
can cause blood pooling and blood clot in atrium
no p wave, IRREGULAR heart beat
AV block 1st degree
PR interval is longer then 1 big box (0.2sec)
Regular HR
AV block 2nd degree
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
AV block 3rd degree
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)
