EKG

Question 1

which limb leads do you use for determining axis

Answer 1

limb leads, frontal coronal plane

aVR, I, III, II, aVF, aVL

Question 2

what is a normal direction of depolaration?

Answer 2

upper right to lower left

an deviation from this leads to left and right deviation

Question 3

positive I and aVF
postitive I and neg aVF
negative I and positive aVF

Answer 3

normal
left axis dev
right axis dev

Question 4

CHD

Answer 4

severe chest pain retrosternal, left across chest into neck, jaw, l arm shoulder, epigastrium and bw shoulders - heavy, pressure, crushing

N/V/diaphoresis, dspnea

Question 5

who has silent AMI

Answer 5

diabetics, old women

usually unusual

Question 6

narrowing distal to thrombus is called what if it is a partial occlusion, full occlusion?

Answer 6

unstable angina or NSTEMI

STEMI for full

Question 7

NSTEMI

Answer 7

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
=

Question 8

Zones of infarction and parts of ekg it effects

Answer 8

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)

Question 9

q’ing out

Answer 9

dead tissue produces a scar and no electrical current goes through
then q will be negative, 1st down deflection

Question 10

what will be high in a NSTEMI?

Answer 10

usually seen with cardiac markers: troponin, CKMB (heart), CK
along with st depression or t wave inversion

Question 11

why do you see changes all across EKG that are similar?

Answer 11

CAD

multiple vessels or all vessels are effected by this

Question 12

STEMI on an ekg

Answer 12

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

Question 13

circumflex corresponds to what leads?

Answer 13

lateral wall
aVL, I

v5-6

Question 14

LAD

Answer 14

anterior wall

v1-4

Question 15

RCA

Answer 15

inferior wall (RV)
II, III, aVF
V3R-V6R

Question 16

PAD

Answer 16

posterior wall

v1-3

Question 17

what leads will you see an old anterior mi

Answer 17

In v2 and v3

v4, I

Question 18

what will you most likely see in a LAD/circumflex infarct?

Answer 18

antero-lateral MI - L coronary a
ST elevation and hyper Q (lateral), ST depression in opposite group
increase J point in v2-6

Question 19

old inferior Mi is shown by?

acute inferior MI?

Answer 19

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

Question 20

posterior MI on ekg

Answer 20

hard to see
ST depression in I, II, III
flip upside down V1 firemans hat
v1 -prom R wave?

Question 21

premature atrial contraction

Answer 21

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

Question 22

premature ventricular contraction

Answer 22

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

Question 23

multiple PVC from an irritable focus

Answer 23

PVC in multiple places
hyperactive ventricle
can be consecutive stimuli and look like vtach
150-200

Question 24

VTACH

Answer 24

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)

Question 25

supraventricular tachycardia and paroxysmal VST

Answer 25

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

Question 26

a fib

Answer 26

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

Question 27

1 degree AV block

Answer 27

pr interval wide, qrs norm

wiring from sa to av is messed up

Question 28

premature junctional beat

Answer 28

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

Question 29

septal MI are found in what leads

Answer 29

v1/v2

Question 30

anterior mi are found in what leads

Answer 30

v3-4