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Rapid Interpretation of EKGs > Chapter 9: Infarction > Flashcards

Chapter 9: Infarction Flashcards

1
Q

A coronary artery can be gradually narrowed by lipid deposits that become ____________ ______ beneath the ______ ______ of the vessel. The intima may eventually rupture, exposing the plaque to the blood within the artery. This initiates the formation of a ________.

A

atheromatous plaque
intima lining
thrombus
(p. 259)

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2
Q

The EKG can tell us which ________ ______ is occluded, and can even reveal any ______ in the ventricular conduction caused by the infarction.

A

coronary artery
blocks
(p. 259)

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3
Q

The coronary arteries originate at the…

A

…base of the aorta.

p. 260

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4
Q

Necrotic, infarcted tissue cannot…

A

…depolarize.

p. 262

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5
Q

Hypoxic ventricular foci in the area of necrosis are often the source of…

A

…serious ventricular arrhythmias.

p. 262

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6
Q

The myocardial infarction triad is ________, ______, and ________, but any of the 3 may occur alone.
Also, not all 3 need to be present in order to _________ myocardial infarction.

A

ischemia, injury, necrosis
diagnose
(p. 263)

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7
Q

The term “ischemia” literally means…

A

…reduced blood supply.

p. 263

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8
Q

The characteristic sign of ischemia on EKG is…

A

…inverted T waves.

p. 264

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9
Q

Angina is usually associated with…

A

…transient T wave inversion.

p. 264

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10
Q

In adults, flat (nonexistent) T waves or minimal T wave inversion may be a ______ _______ in any of the LIMB leads.

A 
normal variant
(p. 265)
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11
Q

However, any T wave inversion in leads __ through __ is considered pathological.

A

V2 through V6

p. 265

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12
Q

Marked T wave inversion in leads V2 and V3, the hallmark of _______ ________, alerts us to ________ of the anterior __________ coronary.

A

Wellens syndrome
stenosis
descending
(p. 265)

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13
Q

Elevation of the ST segment signifies…

It tells us that an MI is…

A

…“injury”.

…acute (recent).
p. 266

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14
Q

Angina without exertion, “Prinzmetal’s” angina, can cause _________ __ _________ in the absence of an infarction.

A

transient ST elevation

p. 266

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15
Q

If the ST segment is elevated without associated _ _____, this may represent ___-_ ____ __________.

A

Q waves, non-Q wave infarction

p. 267

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16
Q

A ventricular aneurysm can cause persistent ST elevation in…

A

…most of the chest leads, and the ST segment does NOT return to the baseline with time.
(p. 267)

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17
Q

Pericarditis produces a unique type of ST segment elevation that may also elevate the _ ____ off the baseline.

A

T wave

p. 267

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18
Q

______ _______ _____ can occur spontaneously in patients with Brugada syndrome.

A

Sudden cardiac death

p. 268

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19
Q

Brugada syndrome is a __________ condition, characterized by RBBB and ST elevation in leads __ to __.

A

hereditary, V1 to V3

p. 268

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20
Q

Brugada syndrome is caused by dysfunctional…

Prophylaxis against the deadly arrhythmias that can result requires…

A

…cardiac sodium channels.

…ICD implantation.
p. 268

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21
Q

Brugada syndrome is responsible for nearly _______ of the sudden deaths in healthy young individuals without structural heart disease.

A

one-half

p. 268

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22
Q

Pericarditis may be caused by…

A

…a virus, bacteria, cancer, or other sources of inflammation, including MI.
(p. 269)

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23
Q

With pericarditis, the ST segment is elevated and usually ____ or _______.

A

flat or concave

p. 269

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24
Q

Name the 3 conditions under which the ST segment may become depressed:

A

subendocardial infarction
positive stress test
digitalis
(p. 270)

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25
Q

A subendocardial infarction does not extend through the ____ _________ of the ventricular ____.

A

full thickness
wall
(p. 270)

26
Q

Subendocardial infarction is a type of _________ MI, and is identified by ____ __ _______ __________.

A

non-Q wave
flat ST segment depression
(p. 271)

27
Q

While classic MI is transmural, a subendocardial infarction must be respected as a ____ __.

A 
true MI
(p. 271)
28
Q

The Q wave is the _____ ________ stroke of the QRS complex, and it is never ________ by anything in the complex. If there is any positive wave, even a tiny spike, before the downward wave, the downward wave is an _ ____ and the upward wave preceding it is an _ ____.

A

first downward, preceded
S wave, R wave
(p. 272)

29
Q

Significant Q waves are ______ in normal tracings.

A

absent

p. 272

30
Q

A significant Q wave indicates ________ and is diagnostic for __________.

A

necrosis, infarction

p. 272

31
Q

A (capital) Q wave is ________, but smaller q waves (lowercase letter) are not significant.

A

abnormal

p. 273

32
Q

Normally, ventricular depolarization begins ______ down the interventricular septum. Septal depolarization (initiated at mid-septum by the ____ Bundle Branch) is _____-to-_____, and this initial rightward ventricular activation may produce tiny, insignificant q waves in leads where the QRS is usually _______.

A

midway
Left, left-to-right
upright
(p. 273)

33
Q

Insignificant q waves are, by definition…

A

…less than one millimeter (0.04 sec) in duration.

p. 273

34
Q

A significant Q wave is at least…

A

…one small square (0.04 sec) wide, or one-third of the entire QRS amplitude.

35
Q

To check for an infarction, we scan all leads (EXCEPT FOR ___!) for the presence of significant Q waves.

A

AVR

p. 275

36
Q

We do not assess lead AVR for Q waves because the lead is…

Basically, lead AVR is like an ___________ lead __, so the large Q waves that are commonly seen in lead AVR are really…

A

…positioned in such a way that data about Q waves are unreliable.

upside-down, II
…upside down R waves from lead II.
(p. 275)

37
Q

An infarct is necrotic; it cannot depolarize and it has no _______. Therefore, the positive electrode nearest the _________ area detects no “toward” or “positive” vectors. A Q wave in inscribed on EKG in the leads which use that positive electrode for recording.

A

vectors
infarcted
(p. 277)

38
Q

An anterior infarct will show Q waves in…

A

…V1 through V4.

p. 277

39
Q

A lateral infarct will show Q waves in…

A

…leads I and AVL.

p. 277

40
Q

An inferior infarct will show Q waves in…

A

…leads II, III, and AVF.

p. 277

41
Q

An infarction evidenced by Q waves in V1 and V2 includes the septum and is called an…

A

…anteroseptal infarction.

p. 278

42
Q

An infarction evidenced by Q waves in V3 and V4 is called an…

A

…anterolateral infarction.

p. 278

43
Q

And remember that insignificant q waves are seen normally in…

A

…V5 and V6.

p. 278

44
Q

The lateral limb leads use the ____ ___ as the positive electrode.

The inferior limb leads use the ____ ____ as the positive electrode.

A

left arm

left foot
p. 279

45
Q

Diaphragmatic infarct is synonymous with…

A

…inferior infarct.

p. 281

46
Q

Autopsy data show that about _________ of inferior infarctions also include portions of the _____ _________.

A

one-third
right ventricle
(p. 281)

47
Q

Left ventricular depolarization may be said to proceed from the ___________ (inner lining) to the __________ (outer surface).

A

endocardium
epicardium
(p. 282)

48
Q

If an acute anterior infarction produces Q waves and ST elevation in V1 and V2, then a posterior infarction would…

A

…appear the opposite.

p. 283

49
Q

In acute POSTERIOR infarction, there is a large _ ____ (the opposite of a _ ____) in V1 and V2, and ST __________ instead of _________.
Remember that R waves in lead I are normally ____ ____.

A

R wave, Q wave
depression, elevation
very tiny
(p. 284)

50
Q

If you suspect an acute posterior infarction (due to large R wave and ST depression in V1 or V2) then try “reversed trans-illumination” or the “mirror test”. These tests require _________ the EKG tracing, then either holding it to a strong light and looking at the back unprinted side, or _________ and then looking at it in a mirror. Now you can see Q waves and ST elevation, just as if it were an ________ infarct.

A

inverting, inverting
anterior
(p. 287)

51
Q

The EKG diagnosis of infarction is generally not valid in the presence of ____ ______ ______ _____.
So, any Q wave originating in the L ventricle could not appear at the beginning of the QRS complex with LBBB; rather it would fall somewhere in the ______ of the QRS complex, making it difficult to detect significant Q waves.
One special exception is possible. The R and L ventricles share the interventricular septum in common. So, an infarct in the septal area would be shared by the right ventricle, which depolarizes _____ in LBBB. This would produce Q waves at the beginning of the wide QRS. Therefore, even in the presence of LBBB, Q waves in the chest leads might suggest (but not _______) antero-septal infarction.

A 
left bundle branch block
middle
first
confirm
(p. 289)
52
Q

The two main arteries of the heart are the ____ and _____ coronary arteries.
The major branches of the ____ coronary artery are the __________ and the ________ __________.

A

left and right
left, circumflex, anterior descending
(p. 291)

53
Q

A lateral infarction is caused by occlusion of the…

A

…circumflex branch of the left coronary artery

p. 292

54
Q

An anterior infarction is caused by occlusion of the…

A

…anterior descending branch of the left coronary artery.

p. 292

55
Q

The posterior portion of the left ventricle is supplied by the…

A

…right coronary artery which wraps around the right ventricle.
(p. 293)

56
Q

True posterior infarctions are generally caused by an occlusion of the…

A

…right coronary artery or one of its branches.

p. 293

57
Q

In addition, the right coronary artery usually supplies blood also to the…

This is why acute posterior infarctions are often associated with…

A

…SA Node, AV Node, and His bundle.

…serious arrhythmias.
p. 293

58
Q

The hemiblocks are blocks of either the ________ or the _________ division of the LEFT bundle branch.

A

anterior, posterior

p. 295

59
Q

The _____ bundle branch does not have consistent, named ____________ of either clinical or electrocardiographic importance (yet).

A

RIGHT, subdivisions

p. 295

60
Q

The word “fascicle” means ______, so any main division of the ventricular conduction system is a fascicle. ____ Bundle Branches as well as both divisions of the LBB are fascicles.

A

bundle
both
(p. 303)

61
Q

Note: pp. 296 - 302 were skipped.

A

This material is not on the exam.

62
Q

The EKG has never become obsolete because it provides…

A

…more cardiac information than any other diagnostic modality. (?? echo??)
(p. 307)

Rapid Interpretation of EKGs (10 decks)

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