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MI/ hypertophy Flashcards

1
Q

Large, diphasic P wave with tall INITIAL component

A

Right atrial hypertrophy

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2
Q

Left Atrial Hypertrophy

A

Large, diphasic P waves with WIDE terminal component

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3
Q

when the second half of the biphasic P wave is larger than the left in V1 suspect:

A

Left Atrial Hypertrophy

may also see a notched P wave in Lead 2

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4
Q

RAD with wide QRS

Rightward rotation in the horizontal plane

A

Right Ventricular Hypertrophy

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5
Q

Right Ventricular Hypertrophy R/S wave

A

R wave greater than S in V1, but R waves get progressively smaller from V1-V6
S wave persists in V5 and V6

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6
Q

How to calculate Left Ventricular Hypertrophy

A

S wave in V1
+ R wave in V5 =
> 35 mm consistent with LVH

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7
Q

LAD with slightly wide QRS

Leftward rotation in horizontal plane

A

Left Ventricular Hypertrophy

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8
Q

LVH T wave pattern?

A

Inverted T wave

slants downward gradually then up rapidly

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9
Q

Reciprocal of Anterior leads V1 and V2?

A

Posterior heart

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10
Q

What is the reciprocal of the lateral leads? I and aVL?

A

Inferior leads!!! II, III, aVF

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11
Q

II, III and aVF lets you see an MI on what wall

A

Inferior wall

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12
Q

V1 V2 V3 and V4

A

Anteroseptal Leads

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13
Q

V5 and V6

I and aVL

A

Lateral Leads

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14
Q

II, III, aVF

A

inferior leads

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15
Q

Ischemia

A

T wave inversion

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16
Q

T wave inversion

what to look for:

A

Inverted T wave is symmetrical (mirror image)
Normally T wave is upright when QRS is upright
Leads with acute infarct show both Q waves and ST elevation
Isolated ischemia may be seen, narrow coronary vessel may be determined by T wave inversion

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17
Q

Myocardial Ischemia EKG

A

> 1mm below baseline at point 0.04 sec to the R of the J point in at least 2 leads facing same anatomical direction
+/- T wave inversion
depression of ST segment is due to delay in repolarization
Note: Flat depression of ST segment- sub endocardial injury

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18
Q

Subendocardial Infarction

A

infarct that doesn’t extend through the full thickness of ventricular wall

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19
Q

ST elevation/depression is a signal of?

A

Acute Injury

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20
Q

ST elevation with significant Q waves indicates:

A

acute infarction

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21
Q

ST depression may represent

A

“subendocardial infarct” or “non-Q wave infarct”

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22
Q

Myocardial Injury

A

> 1mm (limb) or > 2mm (precordial) above baseline at least two leads facing same anatomical direction
elevated ST segment

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23
Q

Benign early repolarization

A

mc in young healthy males- complaint free

NEVER SYMPTOMATIC pt

24
Q

Q wave means

25
Significant Q
> 1mm or 1/3 the amplitude of QRS complex | clue in to MI location
26
MI credentials
Q wave= 1. duration >= 0.04 sec 2. amplitude >= 1/3 of the R wave 3. present in at least 2 contiguous leads
27
reciprocal change- | ST depression means
T wave is UPright
28
Q wave + Reciprocal Change of ST elevation
T wave is flipped
29
Defining leads?
V3 V4 bc R wave progression
30
Q wave in V1-V4
anterior wall infarction of the LV
31
Lateral Wall defining leads
V5 V6 I and aVL
32
Inferior wall defining leads
II, III and aVF
33
What do you see with an MI in the posterior wall
ST depression in leads V1 and V2 Upright T waves R wave >= S wave
34
LAD | what leads have abnormalities
V1-V6 Anterior Septal Anteroseptal
35
Circumflex- | what leads have abnormalities
V4-V6 I, aVL Anterolateral, Lateral, Apical
36
Right Coronary | What leads have abnormalities
II, III, aVF V1-V2 (reciprocial) Inferior, Posterior
37
Subendocardial MI, what leads are involved?
ANY LEADS!
38
Wellens Syndrome | LAD coronary T wave syndrome
``` H/o angina CP, preinfarct stage normal-high cardiac enzymes T wave inversion V2 and V3, NO Q waves no ST elevation normal R progression ```
39
PR
Tachycardia junctional rhythm pre-excitation (WPW- delta waves)
40
> 200ms "normal in"
``` focal fibrosis digitalis ischemic heart disease rheumatic heart disease hyperkalemia ```
41
Wolf Parkinson White there is a
Delta Wave
42
Hyperkalemia | K
Wide flat P wave Wide QRS peaked T
43
Hyperkalemia | K >7.5 mEq
no P wave wide QRS "sine wave" R-S-T sinoventricular rhythm
44
Hypokalemia (
Moderate- flat or inverted T wave U wave Extreme: prominent P + U waves, prolonged QRS duration and QT interval
45
Hypercalcemia | QT is
SHORT
46
Hyopcalcemia | QT is
PROLONGED | this is worse bc you can get the R on T phenomenon
47
Pulmonary Embolism
``` S1Q3T3 wide S in I Large Q and inverted T in III acute RBBB, RAD inverted T in V1-V4 and ST depression in II ```
48
Pericarditis
PR depression, ST depression in: aVR, V1 + V3 diffuse concave up ST segment elevation T wave depression bc ST elevation no reciporical ST changes
49
Pericardial Effusion you will see
Electrical Alternans
50
Electrical Alternans is
beat to beat alternation of QRS appearance | common in tamponade
51
Electrical Alternans is result of
back and forth swinging of the heart in the pericardial sac
52
Digitalis | "digitalis effect"
T wave depressed or inverted QT interval shortened excess (blocks): SA block, PAT with block, AV block, AV dissociation
53
EKG- Prolonged QT is with what mineral/electrolyte thing
Quinine + Quinidine
54
excess Quinidine or hypokalemia may initiate...
Torsades de pointe
55
Pacemakers "triggered"
when pt rhythm ceases or markedly slows
56
Pacemakers "inhibited"
if pts rhythm resumes at a reasonable rate
57
Pacemakers "reset"
to synchronize with premature beat

EKG (2 decks)

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