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EKG MI Flashcards

1
Q

What MOA related to ACS DEC blood flow?

A

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

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2
Q

What MOA related to ACS INC blood flow?

A

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

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3
Q

What are CP of ACS?

A 
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
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4
Q

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

A

STAble ANgina

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5
Q

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

A

UNSTABLE

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6
Q

What are the INF leads?

A

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

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7
Q

What are the Right lateral lead?

A

I and AVL- circumflex

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8
Q

What are the SEPTAL leads

A

V1 and V2-LAD

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9
Q

What are the Anterior Leads

A

V3 and V4-LAD Posterior V1-V3 -RCA

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10
Q

What are the Lateral inf lead?

A

V5 and V6- Left circumflex

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11
Q

Which leads to view for a anterior septal wall STEMI?

A

V1-V4 contiguous

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12
Q

These leads represent an inferior wall STEMI?

A

II, III, AVF.

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13
Q

These leads represent a lateral wall STEMI?

A

I, AVL and V5-V6

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14
Q

What determines ht of ST segment?

A

J point. between QRS and Beg of ST segment

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15
Q

What is required for STEMI of J point?

A

2 anatomical contiguous same lead.

J point high

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16
Q

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

A

V1-V3. Deep ST depression V2

Take off place in back, will then show STEMI

17
Q

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

A

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

18
Q

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

A

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

19
Q

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

A

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

20
Q

What are the reciprocals for lateral leads?

A

II, III, AVF

21
Q

What are the reciprocals for inferior leads?

22
Q

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

A

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

23
Q

What does Q-wave indicate?

A

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
24
Q

What are all possible T wave DX?

A
  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
25
Q

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

A

MI/NSTEMI- Depression morphology

1. ST- upsloping, horizontal, downsloping. Any lead

26
Q

Who are most atypical with MI CP?

A

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

27
Q

What is clinical differnecee with DX MI in labs?

A

STEMI-non elevated.

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

28
Q

What is order with EKG for CP pts?

A

*Troponin, CK-MB, CRP

29
Q

How do you manage STEMI pts?

A
  1. Cardiac monitor 2. O2 3 NTG 4. Cath lab <90min 5. BB 6. morphine 7 Antiplatelets 8. Call cardiology 9 IV access
30
Q

What is management for UA/NSTEMI?

A

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

31
Q

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

A

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.

32
Q

Which leads will identify LBBB w/MI?

33
Q

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

A

Sgarbossa criteria

34
Q

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

A 
Widespread STE concave like V2-V5
J point is fish hook more prominent
Tall T waves V1-V6
Straight descending**
NO RECIPROCAL changes
35
Q

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

A

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

36
Q

What condition is STE + Partial RBBB in V1 and V2

A

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

37
Q

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

A

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

SUMEKG (8 decks)

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