Kev Kards Flashcards
ECG change represents active myocardial injury:
ST-Segment Elevation
Which of the following ECG changes represents myocardial ischemia:
Hyperacute T-Waves
STE leads criteria) Lead I-III
≥ 1mm
STE leads criteria) Lead V1
Lead V2-3
Lead V1 ≥ 1mm
Lead V2-3}≥ 2mm M>40, 2.5mm M<40 1.5 all women
STE leads criteria) Lead V4-6
≥ 1mm
3 I’S of cardiac) ST Elevation:
Injury
STE leads criteria) Lead V4R
Lead V8-9
Lead V4R ≥ 1mm
Lead V8-9 ≥ 0.5mm
Left & Right BBB
STE leads criteria) Lead I-III
≥ 1mm
STE leads criteria) Lead aVR, aVL, aVF
≥ 1mm
STE leads criteria) Lead V4-6
≥ 1mm
STE leads criteria) Lead V4R
Lead V8-9
Lead V4R ≥ 1mm
Lead V8-9 ≥ 0.5mm
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
Leads V3 and V4 look at what part of the heart?
L-Anteriorwall (LAD & LMCA blocks)
Systematic approach
- rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Unipolar Limb Leads:
aVR:
aVL:
aVF:
= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)
V8 & V9 STEMI criteria:
0.5mm or greater
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
ECG Lead coronary arteries) Anterior
(LAD) Left Anterior Descending
Leads II, III and aVF look at what part of the heart?
Inferior wall (most common blockacke(RCA)
ECG Lead coronary arteries) Inferior
(RCA) Right Coronary Artery
A Lateral Wall high view:
B Left Lateral low view:
C Inferior wall view:
D Septal wall view:
E L-Anterior view:
A= Lead I & aVL= LA
B= Lead 1, aVL, V5 & V6: views LCX & LAD
C= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
D= V1 & V2: Along sternal borders blockages from LAD commonly
E= V3 & V4: left anterior wall : LAD & LMCA blocks
ECG Lead coronary arteries) Posterior
(RCA) Right Coronary Artery &/or (LCX)
3 I’S of cardiac) ST depression, Hyperacute or flipped T Wave:
Ischemia
3 I’S of cardiac) ST Elevation:
Injury
3 I’S of cardiac) Pathologic Q
Infarction
ECG Lead coronary arteries) Right
(RCA)
Coronary arteries) Lateral ECG leads to
(LCX) Left Circumflex
STE leads criteria) Lead V4R
Lead V8
Lead V9
V4R 1mm
V8&9 >0.5mm
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
ECG Camera views) Right
Lead V4R
ECG Camera views) Left Lateral
Lead I, aVL, V6, V5
ECG Camera views) Septal
Lead V1 V2
ECG Camera views) Anterior
Lead V3 V4
ECG Camera views) Lateral
Lead V5 V6
ECG Camera views) LMCA - 3 vessel disease
Lead aVR
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
Congitual:
Reciprocal changes:
Spodicks sign:
= same view leads
= mirrored effect in oppisute/corresponding leads for sure MI
= pericarditis PR slopes down aka STEMI imposter
Leads 2, 3, aVF reciprocal leads
leads 1, aVL, V1-6
Leads 1, aVL, V1-6 reciprocal leads
2, 3, aVF reciprocal leads
Wellen’s wave type A:
Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower
Highly specific for for a critical blockage of the LAD
Wellen’s wave type B:
DEEP inverted T waves V2 or V3,
De Winter’s T Waves:
V2 V3 most commonly but can happen any lead
ST depression at the J-point & upsloping ST-segments w/ tall, symmetrical T- waves in the precordial leads (LMCA or LAD occlusion)
“Hyper T w/ STD”
Spodicks sign:
sloping down P wave into QRS (evidence of pericarditis)
3 Is of cardiac) Ischemia:
“Infarct” Injury:
Infarction:
= Ischemia: ST depres/, Hyperacute T waves>5chest avf >10 precordial
= “Infarct” Injury: ST elevation 50%,
= Infarction: old MI; >25% Q or QRS >1SB
RPM:
LAC:
RPM: Posterior & Marginal
LAC: anterior descending circumflex
LBBB Definer Turn criteria
Down deflection before J point “turning left”
Mirror Criteria
V1&2 leads (v2 most sensitive w/ R): ST depression w/ big R wave (accompany 15-20% inferior or lateral STEMI)
Scgarbossa criterias
Scgarbossa criterias
Axis
Scgarbossa 3
Scgarbossa 2
Scgarbossa 1
Axis normal
Axis normal
Axis pys L
Axis) pys L cause:
Normal
Axis Path L cause:
Anterior Hemiblock
Axis QRSs) normal axis leads & Degrees
= all Up) 0° to +90°
Axis QRSs) Pyscio Left leads & Degrees
= U, U, D) 0° to -30°
Axis QRSs) Patho Left leads & Degrees
= U,D,D) -30° to -90°
Axis QRSs) RIght axis leads & Degrees
= D, U/D, U) +90° to +180°
Axis QRSs) Extreme right leads & Degrees
=All down )+180° to -90°
Axis QRSs) all Up
Normal
Axis QRSs) U, U, D
physcio L
Axis QRSs) U, D, D
Patho Left
Axis QRSs) D, U/D, U
RIght
Axis QRSs) D, D, D
Extreme Right
Sgarbossa criteria 1:
Concordant ST elevation ≥ 1 mm in leads w/ a positive QRS.
Sgarbossa criteria 2:
Concordant ST depression ≥ 1 mm in V1-V3.
Sgarbossa smith modified criteria 3:
Discordant ST elevation > .20 QRS amp in leads w/ negative QRS
ST/QRS #= 0.12
Sgarbossa criteria 3:
Discordant ST elevation > 5 mm in leads w/ a negative QRS.
