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12-lead > Chapter 15 AMI > Flashcards

Chapter 15 AMI Flashcards

1
Q

Ischemia pattern

A

Wider area in the epicardium. Narrower area in the endocardium.
Ischemic area is more negative causing ST depression.
T wave is flipped because of abnormal repol pathway.

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2
Q

Injury pattern

A

Wider area in the epicardium, more narrow in the endocardium similar to ischemia.
Zone of injury does not repol completely, remaining MORE positive than surrounding tissue leading to ST elevation.
T wave is flipped because of abnormal repol pathway

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3
Q

Infarction pattern

A

Thicker endocardium thinner epicardium.
Infarcted areas are electrically neutral, like a window an electrode sees the opposite wall. Heading away from the electrode the vector creates a Q wave. The rest of the complex is formed by the surrounding zones of infarcts and injury

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4
Q

Three classes of ACS

A

Unstable angina
NSTEMI
STEMI

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5
Q

UA

A

Three subtypes new onset, rest, crescendo pattern.
Presents as chest pain, SOB, sweating, palpitations, N/V.
12 reads normal or ST depression and or T-wave inversion.
Lab tests for CK-MB or tropes are negative.
UA represent ischemic state which has not progressed to permanent damage.

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6
Q

NSTEMI

A

Similar to UA with ST depression or T wave inversion. Presents like a stemi often.
Lab values ARE elevated.

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7
Q

ECG STEMI criteria

A

Two or more contiguous leads.

Greater than 2mm in V1 V2 V3. 1mm in all the other leads.

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8
Q

II, III, and aVF reciprocal changes

A

I and aVL

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9
Q

V1 and V2 reciprocal changes

A

V7, V8, V9

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10
Q

Old q-wave infarcts often involve

A

Inferior or anterior walls

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11
Q

Inferior infarct arteries

A

RCA, LCx

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12
Q

LCx =

A

Left circumflex artery

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13
Q

Inferior RV infarct arteries

A

Proximal RCA

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14
Q

Inferoposterior infarct arteries

A

RCA, LCx

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15
Q

Isolated RV infarct artieries

A

LCx

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16
Q

Isolated posterior infarct arteries

A

RCA, LCx

17
Q

Anterior infarct arteries

A

LAD

18
Q

Anteroseptal infarct arteries

A

LAD

19
Q

Anteroseptal-lateral infarct

A

Proximal LAD

20
Q

Anterolateral, inferolateral, or posterolateral

A

LCx

21
Q

Anterior wall MI

A

Rarely isolated to anterior. If anterior, septum, and lateral wall are all affected it is called anteroseptal with lateral extension (usually V1-V6 with I and aVL)

22
Q

Anterior septal

A

V1-V4. Associated with hemodynamic compromise and cardiogenic shock, as are all anterior infarcts. Anterior septal do not show reciprocal changes in the limb leads.. If there is ST depression in II III and aVF the infarct is probably affecting the lateral and high lateral areas of the heart as well.
Reciprocal changes would be right posterior

23
Q

Reciprocal changes

A

Cannot occur between precordials and limb leads as they lie in a 90 degree angle to one another (different planes) if ST depression is seen it is ischemia or secondary ischemia.

24
Q

Modified sgarbossa criteria

A

Greater than or equal to 1mm of concordant ST elevation
Greater than or equal to 1mm of ST depression in V1-V3
Greater than or equal to 1mm of concordant STE greater than 25% of the previous S wave

25
Q

General rule for ST elevation in I and II

A 
Pericarditis
Apical infarct (essentially large inferolateral, ST elevation in every lead except aVR and V1) proximal RCA
Aortic dissection causing global infarct (vey rare)
26
Q

Why drugs that drop preload (nitrates, beta blockers, diuretics, morphine) fuck up RVIs

A

LV return is all based on venous pressure, since the RV isn’t working.

27
Q

RVI

A

Elevation in III greater than II
IWMI
V1 elevation possibly extending to V5 V6
V2 depression UNLESS it extends to V5 V6
ST depression in V2 cannot be more than half the elevation in aVF (otherwise inferior - RV - posterior)
More than 1mm elevation in V4R (to V6R)
Because it is a RCA inferior wall is usually involved
3% of the time in is caused by an LCx blockage

28
Q

PWMI

A

Depression in V1 and V2 with upright QRS and upright T waves (often with inferior involvement)
Normal R:S ration, flipped T with ST depression more likely anterior ischemia or non-Q wave AMI.
Remember RVI should have an asymmetric flipped T

12-lead (9 decks)

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