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EKG > Ischemia/Infarction (Exam #2) > Flashcards

Ischemia/Infarction (Exam #2) Flashcards

1
Q

What is the “path” of depolarization in heart tissue?

A

Endocardial → Epicardial (inner to outer)

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2
Q

What is the “path” of repolarization in heart tissue?

A

Epicardial → Endocardial (outer to inner)

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3
Q

Define Myocardial Ischemia. What general changes are seen (2)?

A

Ischemia = REVERSIBLE cell damage due to decreased O2

  • ST segment changes
  • T wave changes
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4
Q

What are the three criteria for Myocardial Ischemia (__ OR __ OR __)?

A 
- ST segment depression
OR 
- T wave inversion
OR 
- Peaked/Symmetrical T waves
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5
Q

Define Myocardial Injury. What general changes are seen?

A

Injury = prolonged ischemia → further cell damage but NO cell death
- ST segment changes

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6
Q

What is the primary criteria for Myocardial Injury?

A

ST segment elevation

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7
Q

What other condition presents with T wave inversion, and how can you differentiate it from Transmural Ischemia?

A

Strain presents with T wave inversion but they are asymmetrical
- Transmural Ischemia = T wave inversion and SYMMETRICAL

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8
Q

What is seen with Subendocardial Ischemia?

A

Transient ST segment depression

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9
Q

What is seen with Transmural Ischemia?

A

Transient ST segment elevation

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10
Q

What causes the T wave inversion seen with Myocardial Ischemia?

A

Delayed repolarization

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11
Q

What causes the T wave changes seen when Subendocardial Ischemia progresses to Transmural Ischemia?

A

Reversal of repolarization causes T wave to invert and become symmetrical

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12
Q

What other condition presents with ST segment elevation, and how can you differentiate it from Myocardial Injury?

A

Pericarditis presents with DIFFUSE ST segment elevation

- Injury presents in respective leads (not diffuse)

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13
Q

Define Myocardial Infarction. What general changes are seen?

A

Infarction = cell death, enzymes released (T)

- Pathologic Q waves

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14
Q

What causes the development of pathologic Q waves?

A

Infarcted tissue is electrically silenced

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15
Q

What are the criteria for Q waves (__ AND __ AND __), and when do these present?

A 
Myocardial Infarction
- 0.04+ seconds in duration
AND
- At least 1/3 the height of R waves in same QRS complex
AND
- Present in 2+ contiguous leads
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16
Q

How can you differentiate Ischemia from Infarction (non-EKG)?

A

Elevated Troponin (T) with Myocardial Infarction

17
Q

How can you differentiate an NSTEMI from a STEMI?

A
  • NSTEMI = ST segment changes + T wave changes (NO Q waves)

- STEMI = ST segment changes + T wave changes + Q waves

18
Q

In what three leads does an Anterior MI present?

A

V2, V3 and V4

- V1 NOT INVOLVED

19
Q

What type of MI presents in V2, V3 and V4?

A

Anterior MI

20
Q

In what two leads does a Septal MI present?

A

V1 and V2

21
Q

What type of MI presents in V1 and V2?

A

Septal MI

22
Q

In what three leads does an Anterolateral MI present?

A

V4, V5 and V6

23
Q

What type of MI presents in V4, V5 and V6?

A

Anterolateral MI

24
Q

In what four leads does a Lateral MI present?

A

I, aVL, V5 and V6

25
Q

What type of MI presents in I, aVL, V5 and V6?

A

Lateral MI

26
Q

In what three leads does an Inferior MI present?

A

II, III and aVF

27
Q

What type of MI presents in II, III and aVF?

A

Inferior MI

28
Q

What are the two criteria for a Posterior MI (hint: be specific with the R waves)?

A

Reciprocal changes in V1 and V2

  • Abnormal R waves in V1 and V2 (0.04+ seconds in duration, R > S, patient is 30+ years old)
  • ST segment depression
29
Q

How can you differentiate a NEW MI from an OLD MI?

A
  • New = ST segment changes + T wave changes + Q waves

- Old = Q waves only

30
Q

What should you suspect if you see ST depression in V1, V2 and V3 with NO other ST elevation in other leads?

A

Posterior MI

31
Q

What finding on EKG is suspicious for Posterior MI?

A

ST depression seen in V1, V2 and V3 with NO other ST elevation in other leads

EKG (8 decks)

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