EKG MI

Question 1

What MOA related to ACS DEC blood flow?

Answer 1

Vasospasm- aa smaller. 2. Fixed stenosis 3. Thrombosis-clots

Question 2

What MOA related to ACS INC blood flow?

Answer 2

Tacy 2. INC contractility 3. HTN- related to INC blood

Question 3

What are CP of ACS?

Answer 3

1. CP- relieve w/ NTG or INC w/ exertion 
1a- substernal
1b-CP via exertion
1c- CP via stress. winter
2. SOB 
3. N/V 
4. Diaphoresis

Question 4

Ms. Heart c/o CP w/ exertion for 10 min but goes away w/ ASA?

Answer 4

STAble ANgina

Question 5

Mr. Heart c/o SOB at rest longer than 20 min, longer, different, does not respond to NTG and is NEW

Answer 5

UNSTABLE

Question 6

What are the INF leads?

Answer 6

II, III, AVF- remember axis of heart- RCA

Question 7

What are the Right lateral lead?

Answer 7

I and AVL- circumflex

Question 8

What are the SEPTAL leads

Answer 8

V1 and V2-LAD

Question 9

What are the Anterior Leads

Answer 9

V3 and V4-LAD Posterior V1-V3 -RCA

Question 10

What are the Lateral inf lead?

Answer 10

V5 and V6- Left circumflex

Question 11

Which leads to view for a anterior septal wall STEMI?

Answer 11

V1-V4 contiguous

Question 12

These leads represent an inferior wall STEMI?

Answer 12

II, III, AVF.

Question 13

These leads represent a lateral wall STEMI?

Answer 13

I, AVL and V5-V6

Question 14

What determines ht of ST segment?

Answer 14

J point. between QRS and Beg of ST segment

Question 15

What is required for STEMI of J point?

Answer 15

2 anatomical contiguous same lead.

J point high

Question 16

Which leads do you suspect a posterior MI if they show horizontal ST depression and upright T-waves, or +/- Tall R waves?

Answer 16

V1-V3. Deep ST depression V2

Take off place in back, will then show STEMI

Question 17

Which leads do you take off and place posterior back to confirm posterior MI?

Answer 17

V4-V6. They become V7-post axill line, V8-inf scapula tip V9-paraspinal

Question 18

Pt is hypotensive with STEMI in V1, LIII. What is DX?

Answer 18

R side MI. TX- AVOID NTG d/t vasodilation in system which INC flow on a damaged IVC R Valve. prevent shock

Question 19

What is also needed in STEMI to check if TRUE MI?

Answer 19

Reciprocal AXIS changes in other LIMB leads only ST depression in reciprocal leads= ACUTE STEMI
Pericordial have no reciprocal

Question 20

What are the reciprocals for lateral leads?

Answer 20

II, III, AVF

Question 21

What are the reciprocals for inferior leads?

Answer 21

I aVL

Question 22

What are changes w/ time in STEMI hours to weeks?

Answer 22

ACute- STEMI HR- DEC R wave, Q wave begins,
Days- T wave inversion + Q wave
3-4d- ST normalize, T wave inverted.
Week-Q wave stays

Question 23

What does Q-wave indicate?

Answer 23

Sign of OLD MI- necrotic muscle does not generate electric force

1. Wide and Deep, >.04sec/1bx
2. > 25%/1/3 of depth of QRS
3. 2mm Depth

Question 24

What are all possible T wave DX?

Answer 24

1. Flat inversion- HYPOkalemia
2. NSTEMI
3. Intracranial pressure
4. WPW
5. Hypertrophic Cardiomyopathy
6. . Digitalis
7. LBBB, RBBB
8. Brugada Type 1- downslope to neg T-wave

Question 25

What is horizontal ST Depression >0.5mm in two contiguous leads w/ T inversion /1mm?

Answer 25

MI/NSTEMI- Depression morphology | 1. ST- upsloping, horizontal, downsloping. Any lead

Question 26

Who are most atypical with MI CP?

Answer 26

DM and Female- thigh pain Four F's. Typical- Shoulder, CP, jaw, neck, toothache,

Question 27

What is clinical differnecee with DX MI in labs?

Answer 27

STEMI-non elevated. | NSTEMI have elevated Troponin. Unstable - normal enzymes, EKG changes

Question 28

What is order with EKG for CP pts?

Answer 28

*Troponin, CK-MB, CRP

Question 29

How do you manage STEMI pts?

Answer 29

1. Cardiac monitor 2. O2 3 NTG 4. Cath lab <90min 5. BB 6. morphine 7 Antiplatelets 8. Call cardiology 9 IV access

Question 30

What is management for UA/NSTEMI?

Answer 30

Telemetry 2. ASpirin 3. BB 4. NTG 5 HEP 6. ACE/ARB 7. Statin 8 consider stress test

Question 31

How do you distinguish true MI if you see a LBBB (V1-V6 RsR')?

Answer 31

ST/S ratio <0.25. Find most prominent R or S w/in LBBB lead. Represent discordance T and ST segmnt opposite of S -wave.

Question 32

Which leads will identify LBBB w/MI?

Answer 32

V1 and V2

Question 33

What is name of criteria to look up if LBBB seen on ACS symptomatic pt?

Answer 33

Sgarbossa criteria

Question 34

Peter is healthy and young. His EKG was noted in the ED and DX has Benign Early Repolarization? what does his EKG look like

Answer 34

``` Widespread STE concave like V2-V5 J point is fish hook more prominent Tall T waves V1-V6 Straight descending** NO RECIPROCAL changes ```

Question 35

Pt has history of infection, rash. ON PE friction rub, pericardial effusion. What do you suspect the EKG looks like?

Answer 35

Widespread concave STE w/ PR segment depression** Tachy AVR V1- STE DEP w/ PR elevation **WIDESPREAD STE w/ CP

Question 36

What condition is STE + Partial RBBB in V1 and V2

Answer 36

Brugada- half bunny ear V1 or V2 (saddle back)or V6 STE-Downsloping ski slope into t-wave invesion Slurred S in V6 SAVE a LIFE if caught TX- ICD

Question 37

What should be charted on PT chart wt syncope-ie. genetic variances, LC, but deadly EKG?

Answer 37

Find this early to prevent Death. 1. NO Brugada 2. NO WPW 3. NO HOCM-LVH 4. NO long QT 5. NO S1Q3T3- Pulmonary effusion