Chest Pain

Question 1

What are the Inferior leads?

What are the Lateral leads?

What are the Anterior leads?

Answer 1

• Inferior: II, III, aVF
• Lateral: I, aVL, V5, V6
• Anterior: V1-V4

Question 2

What are some classic EKG findings in STEMI?

Answer 2

• ST segment elevation 1 mm in two or more continguous leads
• Q waves

Question 3

What are some classic EKG findings in NSTEMI?

Answer 3

• EKG may be normal (rare)
• ST depression
• T wave inversion (often symmetric)

Question 4

Finding ST depression in leads separate from the region of ST elevation (increases/decreases) the probability of MI>

Answer 4

increases

Question 5

Lateral wall MI

• Where is the ST elevation?
• Occlusion of which artery?
• Reciprocal depression where?

Answer 5

• Leads I, aVL, V5, V6
• Left circumflex artery
• Leads II, III, aVF

Question 6

Inferior wall MI

• Where is the ST elevation?
• Occlusion of what artery?
• Reciprocal depression where?

Answer 6

• Leads II, III, aVF
• Right coronary artery (RCA)
• May have associated RV infarct
• Leads I, aVL

Question 7

Where is ST elevation most sensitive & specific for a RV MI?

Answer 7

V2R, V3R, V4R

Question 8

Anterior wall MI

• Where is the ST elevation?
• Occlusion of what artery?
• Reciprocal depression where?

Answer 8

• Leads V1-V4
• LAD
• Inferior leads

Question 9

Posterior wall MI

• Where is the ST elevation? depression?
• Occlusion of what artery?

Answer 9

• Elevation: V8, V9
• Depression: V1-V4
• RCA or circumflex (depends)

Question 10

What are the common cardiac medications administered for an MI?

Answer 10

• Aspirin
• Nitroglycerin
• Morphine
• Heparin
• Beta blockers
• Plavix

Question 11

What medication should you NOT give to a hypotensive patient?

Answer 11

Nitroglycerin

Question 12

You should give this medication to all patients getting fibrinolytic therapy

Answer 12

Heparin

Question 13

Fibrinolysis has the greatest benefit when started within ___ hours of onset of pain

Answer 13

3

Question 14

How do you treat a pulseless VT?

Answer 14

defibrillate ASAP with 200 J

load w/ amiodarone

Question 15

How do you treat unstable VT?

Answer 15

cardioversion 100-200 J

load w/ amiodarone

Question 16

What are the main troponins expressed in the heart?

Answer 16

Cardiac troponin I (cTnI)

Cardiac troponin T (cTnT)

Question 17

What are the main cardiac causes of elevated troponin?

Answer 17

• Heart failure
• Myocarditis

Question 18

CTn

• Begins to rise:
• Peak:
• Persists for:

Answer 18

• Begins to rise 2-3 hrs after
• Peak around **48 hrs **
• Persists for up to **10-14 days **

Question 19

CK-MB

• Begins to rise:
• Peak:
• Persists for:

Answer 19

• Beings to rise 4-6 hrs after
• Elevated at 12 hrs
• Retruns to base w/i 36-48 hrs

Question 20

cTn or CKMB?

• More specific
• Can be used for late diagnosis of MI
• Can detect late infarct

Answer 20

Cardiac troponins

Question 21

Where are these commonly located?

• Aneurysms
• Dissections

Answer 21

• Aneurysms: abdominal aorta
• Dissection: ascending aorta

Question 22

What are troponins?

Where are they expressed?

Answer 22

• Cardiac regulatory proteins that control the calcium-mediated interaction of actin & myosin
• cTnI - heart only
• cTnT - heart, skeletal muscle

Question 23

The diagnosis of acute MI is traditionally relied upon the combination of….

Answer 23

• chest pain
• electrocardiogram manifestations
• elevated biomarkers
• pathology

Question 24

What is creatinine kinase?

What are the combinations?

What do they do?

Answer 24

• Exist as isoenzymes (dimers of M & B chains)
  
  • CK-MM
  • CK-MB
  • CK-BB
• Reside in the cytosol & faciliate transfer of high-energy phosphates in and out of mitochondria