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CC-P Module I ECG and IABP > Module I > Flashcards

Module I Flashcards

1
Q

A 66 y/o Man complains of chest pain for three hours. The 12 lead ECK shows?

A

Inferior Myocardial Infarction

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2
Q

Which coronary artery supplies the majority of the circulation to the inferior portion og the heart?

A

Right Coronary Artery

Supplies the majority of the inferior portion of the heart and some of the posterior portion of the heart.

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3
Q

V1-V6 chest leads are categorized as?

A

Precordial or Unipolar leads

Views the heart from a horizontal plane

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4
Q

What can be used to determine the ST elevation, ST depression, or QRS duration on the ECG?

A

The J-point

J-point is known as the area where the S wave changes direction.

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5
Q

What type of maocardial infarction does the following 12-lead ECG show?

A

Posterior MI

R waves increase, ST depression (reciprocal changes) present in V1-V4.

Development of tall R waves in the Right precordium should be interpreted as evidence of posterior MI.

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6
Q

ST elevation on the ECG tracing can indicate?

A

Injury

The three ST stages are:

ST elevation = injury (acute MI)

ST depression = Ischemia

Q-waves present that measure 25% of the R wave = Infarction

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7
Q

Hyperkalemia > 7.0 can exhibit which of the following changes on the ECG tracing?

A

Tented or peaked T waves greater than 5mm can indicate the presence of Hyperkalemia.

Flattened T waves/U waves present, which occur just after T waves are usually smaller in amplitude than the T wave = Hypokalemia.

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8
Q

A 50 y/o man presents with chest pain for three days. What does the following 12-lead ECG show?

A

Anterior MI

ST elevation present in V3, V4, laed I and aVL

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9
Q

What is a characteristic of the 12-lead ECG for a patient with a history of WPW?

A

The Delta Wave

The delta wave is due to early conduction through the accessory pathway.

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10
Q

Interpret the following ECG tracing.

A

Complete AV Block (third degree)

Charteristics include no constant PRI

P waves are NOT related to QRS complexes

P waves regular to each other

QRS complexes are regular to each other

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11
Q

ST depression can indicate all of the following except?

A

Old Injury

Acute injury is indicated by the presence of ST elevation.

Ischemia, old infarction and digitalis toxicity can present with ST depression.

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12
Q

Q waves present with ST elevation can indicate?

A

Acute Injury

Q wave with ST depression or T wave inversion = Indeterminate

Q wave without ST changes = Old Injury/Infarction

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13
Q

Interpret the following ECG tracing.

A

100% Ventricular Paced Rythm

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14
Q

Your patient presents with epigastric pain, nausea, and vomiting for one hour. He describes his chest pain as “heavy in nature”. What does the following 12-lead ECG show?

A

Inferior Wall MI

ST elevation in leads II, III, aVF

(reciprocal changes in I, aVL)

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15
Q

Interpret the following ECG tracing

A

Polymorphic V-tach

(formerly known as Torsades de pointes)

Polymorphic = QRS will NOT be symetrical.

Monomorphic = QRS waves WILL be symetrical.

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16
Q

Your patient is exhibiting ST elevation in leads II, III, aVF. ST depression is noted in V1-V3. Which of the following may prove hazardous?

A

Nitroglycerin

Pt’s presenting with an inferior wall MI may also have a Right ventricular MI present which would affect filling pressures. Medications that decrease preload are NOT recommended, unless the pt has been managed with IV fluids prior to administration.

(Diagnosis of Right ventricular MI can be done by obtaining a Right-sided 12-lead ECG)

The presence of ST elevation in V4R is a highly sensitive marker for Right ventricular invlovement.

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17
Q

A 55 y/o woman complains of SOB for two days. Identify what the following ECG rythm reveals.

A

Anteroseptal MI

Presents with ST elevation in precordial leads V1 - V4

(reciprocal changes ST depression in II, III, aVF)

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18
Q

In which sequence does blood flow through the heart valves?

A

Tricuspid, Pulmonic, Mitral, Aortic

(Toilet Paper My Ass)

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19
Q

What condition may the following ECG indicate?

A

Hyperkalemia

Peaked or tented T waves indicate Hyperkalemia with usually a serum lab value of > 7.0

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20
Q

Interpret the following ECG tracing

A

Atrial Fibrilation with ST elevation

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21
Q

The ECG may show peaked P waves, flattened/slurred T waves, and appearnce of U waves, which may indicate?

A

Hypokalemia

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22
Q

Interpret the following ECG

A

Atrial Fibrilation with BBB

R-R waves are regularly irregular with no discernible P waves present

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23
Q

Inferior wall MI is caused by occlusion of which coronary artery?

A

RCA

24
Q

The following ECG reveals?

A

Anteroseptal-lateral wall MI

ST elevation is present in leads I, aVL, V5, V6 (lateral wall), V1, V2 (septal), V3, V4 (anterior wall)

Reciprocal changes (ST depression) present in inferior leads II, III, aVF.

25
Q

Intrepret the following ECG tracing

A

Second-degree AVB, Mobitz II

PR interval is constant and there are more P waves present than QRS complexes.

R-R interval is regular because there is a 2:1 conduction that remains constant.

“P waves march out”

26
Q

On 12-lead ECG, posterior wall MI’s manifest as?

A

ST depression in V1-V4 with abnormally tall R waves.

Progression of abnormally tall R waves and ST depression in precordial leads in chest leads V1 V4.

Changing leads to posterior will show ST elevation

27
Q

Interpret the following ECG tracing

A

Pacer Spikes with Failure to Capture

28
Q

Interpret the following ECG tracing

A

Lateral Wall MI

ST elevation in Lateral leads I and aVL

Reciprocal changes in leads II, III, aVF

29
Q

A patient with a history of tricyclic antidepresent overdose can exhibit which of the following on the ECG tracing?

A

Prolonged QT interval

Widened QRS > 0.12 sec.

30
Q

Normal K+ lab value?

A

3.5 - 4.5

31
Q

Interpret the following ECG tracing

A

Idioventricular Rythm

Ventricular rate of 20-40, wide QRS > 0.12 and no P waves present.

Accelerated idoventricular rythm is defined as a ventricular rate of 40-60 beats per minute, wide QRS > 0.12 sec and no P waves present.

32
Q

Interpret the following ECG tracing

A

Second-degree AVB Mobitz Type I (Wenckebach)

33
Q

Your IABP begins to purge during ascent. The triggering mechanism for this function was initiated as a result of which gas law?

A

Boyle’s Law

The expansion (ascent) or contraction (descent) of gas.

Other equipment affected ETT cuff, which may increase in size with ascent.

34
Q

The balloon has dislodged when treating your patient. Which is the most common site that will be affected?

A

Left Radial Artery

35
Q

During transport you note rust-colored “flakes” in the IABP tubing. This indicates?

A

Balloon Rupture

36
Q

Interpret the following IABP strip

A

Early Inflation

If the inflation point is 2mm or more from the dicrotic notch, it indicates early inflation.

Precise timing of the balloon inflation/deflation is essential to achieve hemodynamic effects that increase coronary blood flow decreasing the workload of the heart.

The arterial pressure waveform is ALWAYS used to set and assess the timeing.

Timing should always be assessed in a 2:1 assist ratio so that a comparison of the assisted and unassisted landmarks can be made.

37
Q

The primary trigger used for most IABP operations is the ?

A

CVP Catheter

Most common is the ECG using the R wave.

38
Q

When timing the IABP, inflation should initiate in synchronization with?

A

Dicrotic Notch Indicated on the A-line Pressure Wave

It is important that the inflation of the IAB occurs at the onset of ventricular diastole, noted on the dicrotic notch on the arterial waveform.

39
Q

Identify the following IABP timing strip

A

Late Deflation

Most Potentially Harmful Timing Error!!!

Timing errors cause decrease in arterial pressures, decrease in cardiac output, decrease in ejection fraction, increase in heart rate, increase in pulmonary artery diastolic pressures, and increase in capillary wedge pressures.

40
Q

During transport you experience a complete IABP failure. You should?

A

Cycle the balloon manually every thirty minutes regardless of timing when managing IABP failure

41
Q

Cardiac Responses

A

Decreased contractility = HR increases

Hypoxia = pulmonary arteries constrict (pulmonary hypertension)

Decrease in systemic perfusion = vessels constrict

(except in neurogenic (distrubutive) spinal, septic and anaphylactic shock)

Systemic decrease in vasoconctriction will decrease CO

42
Q

Cardiac Output (CO)

A

Amount of blood pumped by the heart per minute

= HR x Stroke Volume

4-8 L/min

43
Q

Pulmonary Vascular Resistance (PVR)

A

Measures Afterload of Right Heart

Increased PVR = acidosis, hypercapnia, hypoxia, atelectasis, ARDS

Decreased PVR = alkalosis, hypocapnia, vasodilating drugs

50-250 dynes

44
Q

Systemic Vascular Resistance (SVR)

A

Measures afterload of the Left Heart

Increased: hypothermia, hypovolemic shcok, decreased CO

Decreased: anaphylaxis, neurogenic (distributive) shock, spinal shock, septic shock, vasodilating drugs

800-1200 dynes

45
Q

Right Coronary Artery (RCA)

A

Supplies the Right ventricle and in most people the SA node (60%)

Inferior MI

Bradycardia due to SA node involvement

46
Q

Left Coronary Artery (LCA)

A

Complete block of artery caled “widow maker”

Occludes both the LAD and LCX (entire Left heart)

“Left Main”

47
Q

Left Anterior Descending (LAD)

A

Supplies anterior Left ventricle and anterior septum

Anterior MI

Septal MI

Anteroseptal MI

48
Q

Left Circumflex (LCX)

A

Supplies lateral Left ventricle/posterior Left ventricle in 45% of people

Lateral MI

Posterior MI

49
Q

Inferior MI

A

Right Coronary Artery

ST segment changes in II, III, aVF

Obtain a Right-sided EKG (V4R)

Fluid challenge

Use caution with NTG/Morphine

(Fentanyl probably better suited)

Avoid beta blockers

50
Q

Anterior MI

A

Left Anterior Descending Artery

Segment changes in v2, v3, v4

Carries worst prognosis due to large area

“Fona” Fentanyl, oxygen, ntg, asa

“Mona” Morphine, oxygen, ntg, asa

51
Q

Posterior MI

A

Posterior Descending Artery

Posterior Mi is suggested by depression in V1 - V3

Horizontal ST depression

Tall broad R waves (>30ms)

Upright T waves

Dominant R wave (R/S ratio > 1 in V2)

Reciprocal changes not always present

52
Q

Effects of the IABP

A

Increase coronary perfusion

Decrease workload on heart

Timed EKG waveform

Systole = deflated

Diastole = inflated

53
Q

Normal IABP Timing

A

Decreases workload

Increases coronary perfusion

54
Q

Early IABP Inflation

A

Inflation before aortic valve closure

Forces blood back into Left Ventricle

Aortic regurgitation

Decreased CO

Increased SVR

U shape

HARMFUL

55
Q

Late IABP Inflation

A

Inflation after aortic valve closure

Suboptimal augmentation

Decreased coronary perfusion

“W” shape

56
Q

Early IABP Deflation

A

Decreased negative pressure

Increased afterload

Deflation of balloon before systole

“Cliff” Shape (sharp decline like falling off cliff)

57
Q

Late IABP Deflation

A

WORST TIMING ERROR

Increased workload

Increased afterload

Inflation of balloon during systole

“Widened Appearance” shape

HARMFUL

CC-P Module I ECG and IABP (1 decks)

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