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Medical Diagnosis > Lecture 13 (EKG) -Exam 7 > Flashcards

Lecture 13 (EKG) -Exam 7 Flashcards

1
Q

What are you looking at with 12 lead?

A
  • Each lead provides a picture of the electrical activity of the heart.
  • Does not show actual contraction of the heart, (i.e., PEA)
  • Repolarization & depolarization of the atria & ventricles
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1
Q

Why do a 12 lead?

A
  • Suspected ACS
  • Takes a bunch of pictures from different angles
  • Determine if your patient is having a STEM
  • Determine the appropriate treatment based on the results
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2
Q
  • What are the precoridal lead placemets?
  • What is just as important as the location?
A

Site prep is just as important

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3
Q

What is the signs and symptoms of patient of ACS?

A

ST segment elevation that is equal to or greater than 1 mm in two or more contiguous leads or 2mm in men and 1.5mm in women in V2-V3 and is called ST segment myocardial infarction (STEMI)
* indicates acute myocardial injury.

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4
Q

What are the high lateral, lateral, inferior, septal and anterior leads?

A
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5
Q

During acute STEMI, ECG goes through three stages:

A
  • T wave peaking following by T wave inversion
  • ST-segment elevation
  • Appearance of new Q waves
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6
Q
A
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7
Q

What happens with acute stemi?

A
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8
Q
A
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9
Q

Inferior infarction – diaphragmatic surface of heart
* What artery is involved and what leads are elevated?

A

Inferior infarction – diaphragmatic surface of heart – right coronary artery involved – ST- elevation in leads II, III and aVF

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10
Q

Lateral infarction – left lateral wall of heart
* What artery is involved and what leads are elevated?

A

Lateral infarction – left lateral wall of heart – occlusion of left circumflex artery – ST- elevation in left lateral leads I, aVL, V5 and V6

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11
Q

Anterior infarction-anterior surface of heart and left ventricle
* What artery is involved and what leads are elevated?

A

Anterior infarction – anterior surface of heart and left ventricle – occlusion of left anterior descending artery – elevation of leads V1-V4

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12
Q

Posterior infarction – posterior surface of the heart
* What artery is involved and what leads are elevated?

A

Posterior infarction – posterior surface of the heart, occlusion of right coronary artery – no direct leads, look for reciprocal leads in anterior leads, V1, V2 or V3

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13
Q
A
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14
Q

what is this?

A

NSR

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15
Q

What is this?

A

Leads III and aVF, Inferior

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16
Q

What is this?

A
  • elevation of V1, V2, V3, V4
  • Anterior septal
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17
Q

What is this?

A

Elevation in lead 2, 3 and aVF
* Inferior MI

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18
Q

What is this?

A

Elevation II, III, aVF (inferior), V5, V6 (lateral) and reciprocal changes to aVL
* inferior MI

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19
Q

What is this?

A

Elevation II, III, aVF (inferior) and V4, V5 & V6 (lateral)
Reciprocal changes to I & aVL
* Inferior MI

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20
Q

What are the 12-Lead mimics are commonly mistaken forSTEMI Alerts?

A
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21
Q

bundle branch blocks
* What is it?

A
  • A cardiac conduction abnormality seen on the electrocardiogram (ECG)
  • Activation of the left ventricle is delayed, which causes the left ventricle to contract later than the right ventricle
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22
Q

What is a RBBB and LBBB?

A
  • Right bundle branch block, conduction through right bundle branch is obstructed, depolarization is delayed.
  • Left bundle branch block, left ventricular depolarization is delayed.
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23
Q

What causes a bundle branch block? (4)

A
  • Acute ischemia
  • Congenital defect
  • Secondary to hypertension
  • Degenerative heart disease

Some live with BBB and manage the limitations

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24
New or presumably new bundle branch blocks may be candidates for what? * How do you know if it’s new? 
25
Bundle Branch Blocks may * What may it produce and hide?
26
Diagnostic Criteria for Right Bundle Branch Blocks: * What happens with QRS? * What is the pattern in V1-V3? * What happens in lateral leads?
* QRS complex widens beyond 0.12 seconds (in complete) * Incomplete blocks can have a narrow qrs * RSR pattern in V1 through V3, "M" shaped QRS complex, like rabbit ears * Late deep S waves in the lateral leads (I, aVL, V5-V6)
27
What is this?
Right Bundle Branch Block
28
What are the key signs of RBBB in lead I and Lead V1?
29
What is this?
RBBB
30
Diagnostic Criteria Defined LBBB: * What happes to QRS? * What is less common? * What happens in leads I, aVL, V5-6? * What happens to ST and T wave? * What difficult to do what?
31
What is this?
LBBB * V1 dominant S wave * V6 broad, notched R wave (M shaped)
32
What is this?
LBBB – Broad notched R waves in lead leads I, aVL
33
What is this?
RBBB
34
Where do you look for RBBB? and LBBB?
35
* If QRS duration > 0.12 seconds, it is likely what? * If QRS duration > 0.17 seconds, then the ejection fraction is what? * What is ejection fraction? * Healthy people have an ejection fraction between what? * This results from what?
* If QRS duration > 0.12 seconds, it is likely a BBB exists. * If QRS duration > 0.17 seconds, then the ejection fraction is 50% at the most.  * Ejection fraction is the volume percent of blood the heart can pump out.  * Healthy people have an ejection fraction between 60-75% at rest.  * This results from reduced contractility because of the increased time to depolarize; the contraction is also slow and weak.
36
What is this?
LBBB
37
Left Ventricular Hypertrophy * What is it? * Ma not allow what? * Most common cause of what? Other causes include what? * What are sx?(6)
38
Left Ventricular Hypertrophy Diagnostic Criteria * What are the different criteria that can be used? (just the names)
39
Left Ventricular Hypertrophy Diagnostic Criteria * What is increased (2)? * What is a useful method to identify LVH?
* Increased R-wave amplitude in leads that overlay the left ventricle * Increased S-wave amplitude in leads overlying the right ventricle * Useful method to identify LVH:R-wave amplitude in lead V5 or V6 plus the S wave amplitude in lead V1 or V2 exceeds 33 mm
40
What does this show?
Left Ventricular Hypertrophy
41
What is this?
LVH * Increased R wave amplitude in precordial leads over left ventricle * S waves that are smaller in leads over left ventricle (V6) but larger in leads of right ventricle (V1)
42
What is this?
LBBB
43
Pericarditis * What are the sx? * What is CP described as? * Occurs in who? * made worse by what?
* Chest pain, dyspnea, tachycardia, fever, chills, & weakness * Chest pain described as sharp, radiation to back, neck, or jaw * Occurs in younger adults without CAD * Made worse by lying flat or twisting
44
Pericarditis * What is it? * Made better by what? * Ofte what? * Pain last how long? * What can be heard?
* Inflammation of the pericardium (e.g., following viral infection  * Made better by leaning forward * Often pleuritic pain upon  inspiration * Pain lasts hours up to days * Pericardial friction rub (heard over left lower sternal border)
45
What is the Pericarditis Diagnostic Criteria?(4)
* ST segment elevation * Concave in all leads * T-wave elevation * PR depression
46
What does Stage I (acute phase) of pericarditis show on EKG?
Diffuse concave upward ST elevation in most leads, PR depression in most leads (may be subtle), & sometimes notching at end of QRS complex.
47
What does stage 2 show of pericarditis on EKG?
* ST elevation & PR  depression have resolved.       * T waves may be normal or flattened.                                                  
48
What is stage 3 of pericarditis on EKG?
T waves are inverted & ECG is otherwise normal.
49
What is stage 4 of pericarditis on EKG?
T waves return to upright position thus the ECG is back to normal. 
50
Pericarditis * like what? * What is upward? * What are the Three things to distinguish between pericarditis & early repolarization?
51
What is this?
pericarditis * look at hx too
52
What is this?
Pericarditis
53
Early Repolarization * Common in who? * appears as what? * More prominent in what leads?
* Common in healthy young individuals * Appears as mild ST segment elevation that can be diffuse * More prominent in precordial leads ( V1-V6)
54
Early Repolarization * What happens to ST elevation? (2) * Absence of what? * What happens to t wave?
* ST elevation appears like an elevated “J point” * ST elevation is diffuse & concave upward * Absence of reciprocal ST depression * Large symmetrical T wave
55
What is the classic early repolarization ?
56
What are some new definitons of early repolarization?
57
What is this?
Early repolarization
58
What does this show?
early repolarization
59
Pacemakers – Indications for ICD Implantation * What is the primary prevention?
60
Pacemakers – Indications for ICD Implantation * What is the seconary prevention?
61
Pacemakers: * External are used for what? * Typically called what? Applied by who? * External require what? * Pacemakers electrical discharge should what/
62
What does this show?
63
What does this show
64
What does this show?
65
Pacemakers * What should a normal paced rhythm look like?
* Notice the discordance between the QRS complex and T-wave. * The deflection of the QRS complex & T-waves should be opposite.
66
When does a pacemaker fail?
* Failure of the pulse generator or battery * Pacing lead problems * Electromagnetic interference
67
What is this?
68
What is this?
Pacemaker-> atria

Medical Diagnosis (16 decks)

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