Chapter 14 Flashcards
Diffuse j points are associated with
Early repolarization, LVH with strain, and pericarditis. Also AMI with tombstoning present
ST elevation criteria
Less than 1mm limb leads
V2 V3 2mm if older than 40. 2.5 if younger for men, for women 1.5mm
Right ventricular infarct
If inferior, think RV infarct.
No nitrates, fluid load them.
St elevation in V1 (only precordial to look directly at right ventricle) and lead III has greater elevation than II (III is more rightward facing)
Other ways to see RV infarction:
Elevation greater in V1 than V2.
Elevation V1 depression V2 (highly specific)
Isoeletric in V1 st segment plus elevation V2
ST elevation in V4R is 88% sensitive 78% specific
Posterior infarct
ST depression in V1-V4 or ST elevation in V8 V9 no nitro do a 15 lead
T wave height
6mm limb leads 12mm precordial or less than 2/3 height of the QRS. Tall t waves may be ischemia, hyperkalemia, infarction, CNS events.
Very broad T waves
CNS events, intercranial hemorrhage
Pericarditis
First stage (first two weeks)
Concave ST elevation with scooped out appearance and PRI depression everywhere except aVR and V1.
Reciprocal ST depression and PRI elevation in aVR and V1.
Tachycardia
Stage 2 (1-3 weeks)
Normalization of T wave changes, T wave flattening
Stage 3 (3 to several weeks)
Flattened T waves invert
T wave pathology
CNS event, ischemia, hyperkalemia, other electryolyte problems. (Ischemia usually isn’t global)
Ischemic indicators aside from ST elevation or depression
ST segment should be flat and or downward sloping
T waves need to be symmetrical or if biphasic, negative deflection first
You should see a regional distribution of ST elevation or depression
Clockwise/counter clockwise rotation
Normal transition is between v3 and v4
Counterclockwise at or before V3
Clockwise at or after V4
RVH strain pattern
Increased R:S ratio in V1 and V2
Strain pattern includes concave down ST segment that is depressed, and a flipped asymmetric T wave. Or if the t wave is biphasic first part is usually negative.
PE presentation because of the RVH
P-pulmonale Right axis deviation Increased R:S ration in V1 and V2 RVH strain pattern S1Q3T3
Differential for increased V1 or V2 R:S ratio
RVH RBBB Posterior wall MI WPW type A Young kids and adolescents
LVH with strain
ST depression with downward concavity and a flipped asymmetric T wave in V4 to V6
V2 V3 ST elevation with UPWARD concavity and an UPRIGHT asymmetric T wave. ST elevation of 1-3mm
*Strain pattern (and ST elevation) is greatest in the lead with the tallest and deepest QRS (AKA ST elevation should coincide with QRS amplitude)
Q waves in V6 possible
LVH strain VS MI
Strains have asymmetrical T waves, and a concave pattern or more rounded J point
Ischemia or infarction TYPICALLY have a flattened portion of ST elevation with a sharp J point.
