EKG Flashcards
which limb leads do you use for determining axis
limb leads, frontal coronal plane
aVR, I, III, II, aVF, aVL
what is a normal direction of depolaration?
upper right to lower left
an deviation from this leads to left and right deviation
positive I and aVF
postitive I and neg aVF
negative I and positive aVF
normal
left axis dev
right axis dev
CHD
severe chest pain retrosternal, left across chest into neck, jaw, l arm shoulder, epigastrium and bw shoulders - heavy, pressure, crushing
N/V/diaphoresis, dspnea
who has silent AMI
diabetics, old women
usually unusual
narrowing distal to thrombus is called what if it is a partial occlusion, full occlusion?
unstable angina or NSTEMI
STEMI for full
NSTEMI
also called subendocardial injury/death
new chest pain or different pain than what you had before
only part of the wall is dying
had to see on ekg bc only ST segment is elevated
=
Zones of infarction and parts of ekg it effects
ischemia (tall, inverted, depressed T wave, def blood supply, hard to repol)
then injury (def blood supply and inability to fully polarize, ST elevation seg shifts)
finally infarction (dead tissue, lack depolarization, Q wave, q’ing out)
q’ing out
dead tissue produces a scar and no electrical current goes through
then q will be negative, 1st down deflection
what will be high in a NSTEMI?
usually seen with cardiac markers: troponin, CKMB (heart), CK
along with st depression or t wave inversion
why do you see changes all across EKG that are similar?
CAD
multiple vessels or all vessels are effected by this
STEMI on an ekg
ST elevation of 2mm (2 boxes)
at J point in V2-V3 men
1.5mm in women in absence of LV hypertrophy
1mm in 2 or more cont chest/limb leads
tombstone/firemans hat
circumflex corresponds to what leads?
lateral wall
aVL, I
v5-6
LAD
anterior wall
v1-4
RCA
inferior wall (RV)
II, III, aVF
V3R-V6R
PAD
posterior wall
v1-3
what leads will you see an old anterior mi
In v2 and v3
v4, I
what will you most likely see in a LAD/circumflex infarct?
antero-lateral MI - L coronary a
ST elevation and hyper Q (lateral), ST depression in opposite group
increase J point in v2-6
old inferior Mi is shown by?
acute inferior MI?
q’ed, diminished q wave in II, III, aVF, inverted q, ST normal
R coronary infarct
II, III, avF ST elevation, ST depression in v2-3
posterior MI on ekg
hard to see
ST depression in I, II, III
flip upside down V1 firemans hat
v1 -prom R wave?
premature atrial contraction
extra p wave, norm sinus rhythm, sometimes have pause behind the PAC because it wants to go to normal
seen in stress, alc, tobacco, caffeine, copdf, cad
premature ventricular contraction
no p wave QRS wide >3 boxes takes a long time to depolarize in the purkinjes if wide - ventricles usually just one here and there
multiple PVC from an irritable focus
PVC in multiple places
hyperactive ventricle
can be consecutive stimuli and look like vtach
150-200
VTACH
paroxysmal ventricular tachycardia
from CAD, HF, hypertrophic cardiomyopathy, chd, electrolyte abnormalities
no p, wide QRS, Torsade de points (look like a twisted party streamer - big then small)
supraventricular tachycardia and paroxysmal VST
narrow QRS, P (or can come after) and T joined, fast HR 160-180
ap above AV node but so fast you cant see
kids arrthymias
TD, caff, med w stim, stress
has this throughout
PSVT - see the abnormal then goes normal
a fib
can’t make out p/not always there, abnormal rate and rhythm,
hypertensive HD, valve HD, chf, cad, obese, dm, chronic kdiney disease
350-600
irregularly irregular
f - waves = many p waves
1 degree AV block
pr interval wide, qrs norm
wiring from sa to av is messed up
premature junctional beat
brady, >40
av node sends ap
QRS reg but no p or inverted p (can be after qrs too) wave(comes from av junction)
if p is later or not on the ekg, then pr interval will be short
longer pr interval
if accelerated then inverted p 100> tachy
septal MI are found in what leads
v1/v2
anterior mi are found in what leads
v3-4
