Myocardial Infarction/ECG Flashcards
What are the limb leads?
I, II, III, AVR, AVL, AVF
In what plane do the limb leads show depolarization?
Coronal plane
What are the precordial leads?
V1 - V6
In what plane do the precordial leads show deplorization?
Transverse (horizontal) plane
What is meant by the cardiac axis?
Overall depolarization direction of the heart in the coronal plane
What leads do you look at to determine the cardiac axis?
I and AVF
If the QRS complex is deflected upward (+), where is the depolarization moving?
Towards lead
If the QRS complex is deflected downward (-), where is the depolarization moving?
Away from the lead
What is the normal axis?
0-90 degrees
How do you plot the cardiac axis?
Take the number of boxes the leads I and AVF QRS complexes move (NET) and graph against each other.
Normal axis
(+) Lead I and (+) Lead AVF
Left axis
(+) Lead I and (-) Lead AVF
(+) lead I and (-) lead AVF
Left axis
Right axis
(-) Lead I and (+) Lead AVF
(-) lead I and (+) lead AVF
Right axis
What are the main symptoms of coronary artery disease/STEMI?
Chest discomfort that radiates to neck, jaw, shoulder, left arm
Sweating, nausea, vomiting, shortness of breath
STEMI means the coronary A. is?
Occluded
What are the 3 zones of infarction?
- Ischemia (compromised)
- Injury (dying tissue)
- Infarction (dead tissue)
With ischemia, what EKG change will be registered?
T wave changes
With injury, what EKG change will be registered?
ST segment shifts up or down
With infarction, what EKG change will be registered?
Q wave
Main cardiac biomarker of necrosis?
Troponin I or T
What can cause a false positive cTnT (troponin)?
Renal failure
How soon after an acute MI is Troponin detectable?
1-4 hours
NSTEMI has ____ ST elevation
NO
NSTEMI, changes in troponin levels?
Increase!
What changes are seen with a NSTEMI?
T wave inversion because NSTEMI does not cause complete occlusion of the artery
STEMI has ST elevation of more than ___ in males
2 mm
STEMI has a ST elevation of more than ____ in females
1.5 mm
STEMI = complete occlusion of blood flow =
ACUTE MI
What leads measure the anterior heart?
V1 - V4
What artery supplies the anterior heart?
LAD - anterior interventricular
What leads measure the posterior heart?
V1 - V3
What artery supplies the posterior heart?
PDA - posterior interventricular
What leads measure the inferior heart?
II, III, AVF
What artery supplies the inferior heart?
Right coronary A.
What leads measure the lateral heart?
I, AVL, V5, V6
What artery supplies the lateral heart?
Circumflex
What will you need to do in order to see ST segment elevation with a posterior infarction?
FLIP the EKG
What classifies a sinus rhythm?
P wave before every QRS complex
HR > 100 with p wave before every QRS
Sinus Tachycardia
HR < 60 with p wave before every QRS
Sinus Bradycardia
Ectopic beats
Cardiac depolarization originates from a place other than the normal pathway
Premature Atrial Contraction looks like what on an EKG?
Normal, then a random weird looking P wave with a pause longer than normal after it
Premature Ventricular Contraction looks like what on an EKG?
Weird, random QRS complex
Where is the beat with a Premature Atrial Contraction (PAC)?
Ectopic foci in atria
Where is the beat with a Premature Ventricular Contraction (PVC)?
Ectopic foci in the ventricles
Can you have multiple ectopic foci?
YES, waves will look different
Bigeminy
Every other beat is a PVC
Trigeminy
Every third beat is a PVC
Ventricular Tachycardia (VTACH)
Sudden, rapid ventricular foci paces rapidly
- sustained, nonsustained or pulseless
How does Ventricular Tachycardia look on an EKG?
WIDE QRS complex!!
Supraventricular Tachycardia (SVT)
Rapid atrial foci paces rapidly
How does Supraventricular Tachycardia look on an EKG?
P wave likely hidden behind T wave
NARROW QRS complex!!
Atrial Fibrilation, what is it and how is it described?
Chaotic quivering in atria - IRREGULARLY IRREGULAR
How does Atrial Fibrilation look on an EKG?
Undulating baseline
No discernible P waves
IRREGULAR R-R interval!
AV blocks
Any conduction block between SA node and Purkinje fibers
1st degree AV block
PR Interval > 0.2 seconds
With 1st degree AV block, what measurement on the EKG can you use to diagnose?
PR interval is longer than 1 big box
What are the 2 types of 2nd degree AV block?
- Mobitz type 1 (wenkebach)
2. Mobitz type 2
Mobitz Type 1 (wenkebach)
2nd Degree AV block
- Progressively lengthening PR intervals until 1 QRS complex fails
Mobitz Type 2
2nd Degree AV block
- NO change in PR intervals but still a sudden QRS complex fail
3rd degree AV block
NO atrial impulses conduct to the ventricles
= Atria and ventricles are depolarizing completely INDEPENDENT of each other!
Do PR intervals lengthen with Mobitz Type 2, second degree AV block?
NO
Do PR intervals lengthen with Mobitz Type 1, second degree AV block?
YES