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

Lecture 13 (EKG) -Exam 7 Flashcards

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USMLE® Step 1 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
Q

New or presumably new bundle branch blocks may be candidates for what?
* How do you know if it’s new?

A
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25
Q

Bundle Branch Blocks may
* What may it produce and hide?

A
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26
Q

Diagnostic Criteria for Right Bundle Branch Blocks:
* What happens with QRS?
* What is the pattern in V1-V3?
* What happens in lateral leads?

A
  • 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)
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27
Q

What is this?

A

Right Bundle Branch Block

28
Q

What are the key signs of RBBB in lead I and Lead V1?

A
29
Q

What is this?

A

RBBB

30
Q

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?

A
31
Q

What is this?

A

LBBB
* V1 dominant S wave
* V6 broad, notched R wave (M shaped)

32
Q

What is this?

A

LBBB – Broad notched R waves in lead leads I, aVL

33
Q

What is this?

A

RBBB

34
Q

Where do you look for RBBB? and LBBB?

A
35
Q
  • 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?
A
  • 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 themost.
  • Ejection fraction is the volume percent of blood the heart canpump out.
  • Healthy people have an ejection fraction between 60-75% at rest.
  • This results from reduced contractility because of the increasedtime to depolarize; the contraction is also slow and weak.
36
Q

What is this?

A

LBBB

37
Q

Left Ventricular Hypertrophy
* What is it?
* Ma not allow what?
* Most common cause of what? Other causes include what?
* What are sx?(6)

A
38
Q

Left Ventricular Hypertrophy Diagnostic Criteria
* What are the different criteria that can be used? (just the names)

A
39
Q

Left Ventricular Hypertrophy Diagnostic Criteria
* What is increased (2)?
* What is a useful method to identify LVH?

A
  • 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
Q

What does this show?

A

Left Ventricular Hypertrophy

41
Q

What is this?

A

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
Q

What is this?

A

LBBB

43
Q

Pericarditis
* What are the sx?
* What is CP described as?
* Occurs in who?
* made worse by what?

A
  • Chest pain, dyspnea,tachycardia, fever, chills, &weakness
  • Chest pain described as sharp,radiation to back, neck, or jaw
  • Occurs in younger adultswithout CAD
  • Made worse bylyingflat ortwisting
44
Q

Pericarditis
* What is it?
* Made better by what?
* Ofte what?
* Pain last how long?
* What can be heard?

A
  • Inflammation of thepericardium(e.g., followingviral infection
  • Made better by leaningforward
  • Often pleuritic pain upon inspiration
  • Pain lasts hours up to days
  • Pericardial friction rub(heardover left lower sternal border)
45
Q

What is the Pericarditis Diagnostic Criteria?(4)

A
  • ST segment elevation
  • Concave in all leads
  • T-wave elevation
  • PR depression
46
Q

What does Stage I (acute phase) of pericarditis show on EKG?

A

Diffuse concave upward ST elevation in most leads, PR depression in most leads (may be subtle), & sometimes notching at end of QRS complex.

47
Q

What does stage 2 show of pericarditis on EKG?

A
  • ST elevation & PRdepression have resolved.
  • T waves may be normal or flattened.
48
Q

What is stage 3 of pericarditis on EKG?

A

T waves are inverted & ECG is otherwise normal.

49
Q

What is stage 4 of pericarditis on EKG?

A

T waves return to uprightposition thus the ECG isback to normal.

50
Q

Pericarditis
* like what?
* What is upward?
* What are the Three things to distinguish between pericarditis & earlyrepolarization?

A
51
Q

What is this?

A

pericarditis
* look at hx too

52
Q

What is this?

A

Pericarditis

53
Q

Early Repolarization
* Common in who?
* appears as what?
* More prominent in what leads?

A
  • Common in healthy young individuals
  • Appears as mild ST segment elevation that can be diffuse
  • More prominent in precordial leads ( V1-V6)
54
Q

Early Repolarization
* What happens to ST elevation? (2)
* Absence of what?
* What happens to t wave?

A
  • ST elevation appears like an elevated “J point”
  • ST elevation is diffuse & concave upward
  • Absence of reciprocal ST depression
  • Large symmetrical T wave
55
Q

What is the classic early repolarization ?

A
56
Q

What are some new definitons of early repolarization?

A
57
Q

What is this?

A

Early repolarization

58
Q

What does this show?

A

early repolarization

59
Q

Pacemakers – Indications for ICD Implantation
* What is the primary prevention?

A
60
Q

Pacemakers – Indications for ICD Implantation
* What is the seconary prevention?

A
61
Q

Pacemakers:
* External are used for what?
* Typically called what? Applied by who?
* External require what?
* Pacemakers electrical discharge should what/

A
62
Q

What does this show?

A
63
Q

What does this show

A
64
Q

What does this show?

A
65
Q

Pacemakers
* What should a normal paced rhythm look like?

A
  • Notice the discordance between the QRS complex and T-wave.
  • The deflection of the QRS complex & T-waves should be opposite.
66
Q

When does a pacemaker fail?

A
  • Failure of the pulse generator or battery
  • Pacing lead problems
  • Electromagnetic interference
67
Q

What is this?

A
68
Q

What is this?

A

Pacemaker-> atria

Medical Diagnosis (16 decks)

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