Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

2020 CPR II Cardio Exam 1 > ECG: STEMI and NSTEMI (Johnston) > Flashcards

ECG: STEMI and NSTEMI (Johnston) Flashcards

1
Q

What is the underlying condition/ECG changes called if coronary flow is fully occluded vs. partial occlusion?

A
  • Fully occluded = STEMI
  • Partial = Unstable Angina or NSTEMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which type of MI is sympathetic hyperactivity (↑ HR, ↑ BP) vs. parasympathetic hyperactivity (↓ HR, ↓ BP) seen in?

A
  • Sympathetic = anterior MI
  • Parasympathetic = inferior MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 4 PE findings associated with HF?

A
  • S3
  • Crackles
  • ↑ JVD
  • New murmur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Everything as far as presentation and ECG will be the same for NSTEMI and NSTE ACS, except for what?

A

NSTEMI will have elevated cardiac enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which cardiac conduction abnormality can obscure ST elevation analysis and may hide the manifestations of a STEMI?

A

New LBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which ECG changes will be seen in the early acute phase of a STEMI?

A
  • T wave increase in amplitude (like seen in hyperkalemia)
  • Hyper-acute pattern
  • Convex upward ST pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Besides STEMI, what are 3 other causes of ST segment elevation?

A
  • Pericarditis
  • LVH w/ J point elevation
  • Normal variant (early repolarization) common in young males and african americans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a patient with no chest pain and who seems normal has this ECG, what is one characteristic that tells you it’s likely not a STEMI?

A
  • ST elevations are concave (if convex that would be early/acute MI)
  • This is early repolarization a normal variant in young males
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In the chronic phase following STEMI, if there is persistent ST elevation (after 2 weeks) what complication should you suspect?

A

LV aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Q waves shouldn’t be more than how many seconds in width?

A

No more than .03 sec in width

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which lead is the T wave normally inverted and may be variable in which?

A
  • Inverted in aVR
  • Variable in lead III
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which waves/segments of the ECG represent ischemic pattern, injury pattern, and pattern of necrosis/infarction?

A
  • Ischemia –> impaired repolarization –> T waves changes (inverted/tall/peaked)
  • Injury –> inability to fully polarize –> ST elevations
  • Infarction/necrosis –> lacks depolarization –> Q wave or QS complex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Since there are no posterior leads, how do we view a posterior wall infarction and look for what?

A
  • Look at V1-V3 (anterior leads) and will be a mirror image
  • So looking for ST depression and a prominent R
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

After several weeks or months following an MI what Q, R, T and ST changes will exist?

A
  • Significant Q wave usually persists
  • Some R wave may return
  • T wave often less inverted
  • ST elevation may persist IF aneurysm develops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does this ECG signify and how can you tell?

A
  • Recent MI of LAD (leads V1-V6)
  • Massive Q waves + T wave inversion + ST elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is your interpretation of this ECG?

A

STEMI - Anterior Wall (LAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the ECG indicative of?

A
  • Anterior wall STEMI w/ left anterior hemiblock
  • The L.A.D and small R waves in II, III, and aVF meet criteria for left anterior hemiblock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Patient presents with what appears to be an MI and this is his ECG, where is the infarction and why?

A
  • TRUE Posterior infarct
  • Based on the reciprocal changes in anterior leads;
  • V1 shows large R (reciprocal of posterior Q) and upright T wave (reciprocal of posterior T inversion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of MI is this indicative of?

A

Posterior wall infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pt presents w/ chest pain and what looks do be an MI, this is his ECG, what do you suspect?

A

NSTEMI or NSTE ACS

*Need enzymes*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Failure of which organ can give false positive elevations of Troponin T (CTnT)?

A

Renal failure, since is excreted by kidneys

22
Q

For patient with acute STEMI what are the reperfusion strategies if hospital has cath lab and how soon?

A
  • Primary percuteanous coronoary intervention (PCI) w/ angioplasty and stenting
  • Cath lab within 90 minutes (goal)
23
Q

If hospital does not have cath lab or there isn’t time to get to one what is done for acute STEMI and how quickly?

A
  • Give fibrinolytic or thrombolytic
  • Begun in ED within 30 mins. (goal)
24
Q

After beginning fibrinolysis therapy in pt with acute STEMI if there is failure of ST elevation to resolve by >50-70% within 1-2 hours this suggests what?

A

Failure of fibrinolysis

25
If your hospital does not have a cath lab (non PCI capable) how soon must patient with acute STEMI be transferred?
Within **120 minutes**
26
What is the primary reperfusion therapy for STEMI with sx's \<12 hours?
Primary PCI
27
What is a benefit of primary PCI vs. fibrinolytics for STEMI?
**Lower** mortality rate and **less chance** of **intracerebral hemorrhage**
28
Fibrinolytic therapy for reperfusion is useful in what instances, but carries what risk?
- For **STEMI** or **new LBBB** within 12 hours of onset of sx's - **Major risk** = **ICH**
29
What are the major contraindications for administering fibrinolytic therapy?
- **Active bleeding** (**menses is excluded!**) - Prior hemorrhagic stroke - Severe uncontrolled HTN - **Recent major trauma/surgery** - Acute peptic ulcer - **Pregnancy**
30
Which drug should be given on presentation/immediately for STEMI, unless contraindicated?
Aspirin
31
After aspirin, what other drugs should be given alongside fibrinolytic agents for STEMI?
- IV Heparin - Antiplatelet agent (clopidogrel)
32
If STEMI pt receives PCI w/ stenting which drugs should be given for at least 1 year to prevent stent stenosis?
- Aspirin AND - Antiplatelet agent (clopidogrel)
33
What is the additional standard tx while hospitalized for STEMI?
- **M**orphine - **O**2 - **N**itroglycerin - **A**spirin - **Beta**-**blocker** if ↑ BP or ↑ HR - **ACEI** = helpful if EF ↓, ↑ BP; prevent remodeling
34
Tx for NSTEMI will depend first on assessment for high risk pt, which includes what factors?
- **Age** **\>65** w/ **\>3 CAD** risk factors - **Prior** stenosis - **ST deviation** - **\>2 anginal events \<24 hrs** - **Elevated** cardiac enzymes
35
In pt's at **highest risk** for complications presenting with NSTEMI what should be done and how soon?
Cardiac cath lab **within 48 hrs** (consider PCI or CABG if indicated)
36
For high-risk unstable pt's with NSTEMI who undergo PCI, which type of drug should be considered?
IV **GP IIb/IIIa antagonist**
37
Which anti-ischemic therapies should be given for NSTEMI?
- Nitroglycerin (don't use if recently taken PDE-5 inhibitor) - Beta-blocker if HR is ↑
38
After admitting/monitoring pt with NSTEMI what are some additional drugs to consider giving?
- **Morphine** for refractory chest pain - **High dose statin** initially - Consider **ACE-I**
39
If there is recurrent chest pain that may be atypical for them, 2-4 days post-MI, what complication should be considered? How about recurrent chest pain 2-10 weeks post-MI?
- **2-4 days** = acute **pericarditis** - **2-10 weeks** = could be **Dressler Syndrome** (**immune mediated**)
40
Treatment for acute pericarditis/Dressler syndrome as a post-MI complication?
Aspirin, NSAIDs
41
After performing reperfusion on pt with MI you see this on ECG, what is your interpretation and what should be done?
- Accelerated idioventricular rhythm (**60-100 BPM**) - Indicates reperfusion following fibrinolytic and is a **good sign** - **Benign**
42
Which type of heart block is often associated with an **inferior** wall MI?
**2nd degree AV block** (**Wenckebach**)
43
How does the tx for 3rd degree AV block differ if associated with anterior or inferior wall MI?
- **Anterior** wall MI will **require a pacemaker** - **Inferior** wall MI will usually be **transient** and **NOT** require a pacemaker and if it does it will only be a **temporary** pacemaker
44
RV infarction is a potential complication of an MI where and presents how?
- **Inferior** MI - ↓ BP, clear lungs, and ↑ JVP - **Kussmaul sign** (distention of jugular vein on inspiration)
45
What is tx for RV infarction as complication of inferior STEMI?
**IV fluids**
46
What are complications of the LV/septum which can arise post-anterior wall STEMI?
- **Septal rupture** --\> VSD - **LV free wall rupture** (typically 7 days) --\> causes **tamponade** - **LV aneurysm** (persistent ST elevation weeks after MI)
47
Tx for LV free wall rupture post-MI?
Surgery
48
What are thromboembolic complications which can arise from a LV aneurysm?
Arterial **emboli** ---\> **stroke** or **ischemic bowel**
49
Proximal occlusion of RCA before acute marginal branch can cause an MI where? Use what leads and look for what?
- Acute **inferior** wall MI ---\> **RV infarction** - Use **R** precordial leads (V4R- V6R) for RV - **ST elevation** of **1mm or \>** in **V4-V6R**
50
List 4 conditions which can present like STEMI and should be differentials?
- Pericarditis - Myocarditis - Stress induced (takotsubo) syndrome - Early repolarization

2020 CPR II Cardio Exam 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions