CVPR Week 2: Heart model and ECG Part II Flashcards
Objectives
Localization using EKG leads
What leads would represent the inferior portion of heart?
II, AVF, III
What leads would represent the left portion of the heart?
What leads would represent the inferior portion of heart?
- left: AVL, I
- inferior: II, AVF, III
Limb leads vs precordial leads
2D vs 3D
Precordial lead placement
V1 - V6
V1 lead placement
V2 lead placement
V3 lead placement
V4 lead placement
V5 lead placement
V6 lead placement
How to group EKG leads based on the area of the heart?
SALLI
“SALLI”
Septal
Anterior
Lateral
Lateral
Inferior
Basic Coronary Artery anatomy
3 main coronary arteries that need to know
- right coronary artery
- Left anterior descending
- Circumflex coronary artery
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Basic Coronary Artery anatomy branches
3 main coronary arteries that need to know
right coronary artery
Left anterior descending
Circumflex coronary artery
3 main Coronary arteries and location
3 listed
Identify
Right dominant Basic Coronary Artery anatomy
Basic Coronary Artery anatomy hemispheric dominance
Right dominant coronary artery anatomy diagram
Septal Lead localization
V1/V2
Anterior Lead localization
V3/V4
Lateral Lead localization
V5/V6 - left lateral
I/AVL - left lateral
Inferior Lead localization
II/III/AVF
V1/V2 represent
Septal
V3/V4 represent
Anterior
V5/V6 represent
Lateral
I/AVL represent
Lateral
II/III/AVF represent
inferior
Which coronary artery supplies the septal wall?
LAD
Which coronary artery supplies the Anterior wall of the left ventricle?
LAD
Which coronary artery supplies the lateral wall of the left ventricle?
Circumflex artery
Which coronary artery supplies the high lateral wall of the left ventricle?
mostly circumflex but sometimes LAD
Which coronary artery supplies the inferior wall of the left ventricle?
Posterior descending artery
How do V1 and V2 represent the septum?
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What can an EKG tell us about blood flow to the heart?
What is worse Ischemia, injury (acute) or necrosis
Ischemia >>>> Injury (acute) >>>> Necrosis (chronic)
What to look at to determine a occlusion to the heart
look at the ST segment and T wave
Partial occlusion of a coronary vessel and EKG
EKG manifestations of partial occlusion DO NOT localize!!!
T wave inversions and ST depression
Subendocardial infarct
T wave inversions
- significant if deep, new, QRS is upright
- typically symmetric
- T wave inversions do not always mean ischemia if they are not new, deep, or have been there for awhile
ST Depression
Complete occlusion of a coronary artery and EKG
transmural infarct = full-thickness infarct
transmural infarct AKA
full-thickness infarct
Manifestations of a complete coronary artery occlusion
Hyperacute T waves minutes to hours
will progress to
ST elevation
accompanied by Q-Wave when the tissue is dead
These do localize
Hyperacute T waves
- V2 to V4 on this EKG so this is probably a LAD complete occlusion
- only occurs for minutes to an hour
ST Elevation
- J point is the junction between the termination of the QRS complex and the beginning of the ST segment
- TP segment used as a baseline to compare
- What classifies as ST elevation on an EKG
- New ST elevation at the J point in two contiguous leads of >0.1 mV in all leads other than leads V2-V3
- For leads V2-V3 the following cut points apply
- .2> mV in men over 40
- .25mV in men
- .15 mV in women
What area of heart and what vessel?
V2-V6 and I, AVL, so this is probably the Large LAD occlusion so anterior wall and lateral wall
Q waves
Mechanism of Q waves
caused by septal depolarization
Pathologic Q waves
Normal vs pathologic Q waves
deep or wide pathologic
shallow and skinny probably normal
Are there Q waves?
V2-V4 has died
Reciprocal changes seen with STEMI
ST depression of the opposite side of the infarct called reciprocal changes
most of the time see these changes in the inferior leads if in the anterior
Reciprocal changes diagram
infarct in inferior portion will see reciprocal changes in I and AVL
Posterior MI
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