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Clinical Methods > Peripheral Vascular System & Ischemia Part 2 > Flashcards

Peripheral Vascular System & Ischemia Part 2 Flashcards

1
Q

What occurs when one of the coronary arteries becomes totally occluded?

A

Myocardial Infarction

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2
Q

What may cause an MI? (6)

A

Occlusion – thrombosis
Coronary artery spasm – smooth muscle constriction
Decreased coronary artery blood flow
Increased myocardial workload
Decreased O2 levels
Toxic exposure to cocaine and ethanol

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3
Q

What are some signs when diagnosing an MI?

A

Prolonged substernal chest pain with radiation of pain to jaw or left arm (>30min), nausea, diaphoresis, and shortness of breath

Or, pt can have a “Silent MI”

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4
Q

What cardiac enzymes are affected in an MI? (3)

A

Troponin I: rise early and stay elevated for days*
CK-MB: 6 hours to rise and then normalize in 48 hours
CK

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5
Q

KNOW

What ECG changes when diagnosing an MI? (3)

A

T wave changes: first peak then inversion
ST segment elevation/depression: usually elevation with MI
Q waves: indicate irreversible myocardial cell death

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6
Q

What is the first enzyme indicator of a MI? How long will it remain elevated?

A

troponin

5-7 days

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7
Q

What cardiac enzyme will be elevated within 6 hours?

A

CK-MB

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8
Q

What are the stages of an AMI? (Acute MI)

(4)

A

T wave peaking
ST segment elevation
Appearance of new Q waves
T wave inversion

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9
Q

What is occuring with this waveform?

A

ISCHEMIA

Note: T wave inversion is not diagnostic of MI. If true infarct occurs – inversion can persist for months to years.

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10
Q

What part of the ECG reflects myocardial injury?

A

ST segment elevation

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11
Q

Is ST segment elevation reversible?

A

Yes, may reflect some damage, but still reversible and can return to normal.

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12
Q

What is a type of ST segment elevation seen in normal hearts?

A

J Point – where the ST segment takes off from the QRS complex

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13
Q

How do you distinguish a J point from MI? (2)

A

T wave maintains its independent waveform

In MI, elevation is bowed upward and tends to merge with T wave

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14
Q

Over ___ mm of ST segment elevation is clinically significant.

A

1

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15
Q

What ECG wave indicates irreversible myocardial death, is diagnostic of MI, usually appears within hours of infarct, and is persistent for a lifetime?

A

Q waves

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16
Q

During an infarction, ST segment usually goes back to baseline by the time Q waves appear. True or false?

A

True

17
Q

Q wave > ____ sec in duration and depth at least ___ height of R wave signifies MI.

A

0.04

1/3

18
Q

In leads distant from the site of infarction, will see these ECG changes: (2)

A

Tall R waves
ST segment depression

19
Q

What artery supplies the anterior portion of the heart and most of the interventricular septum?

A

LAD

20
Q

What part of the heart does the LAD supply?

A

supplies the lateral wall of the left ventricle

21
Q

What is caused by occlusion of right coronary artery or descending branch of left coronary artery?

What leads will show changes?

A

inferior infarcts

II, III, AVF

22
Q

Reciprocal changes will be seen in these leads in inferior infarcts: (2)

A

anterior

lateral leads

Note: also will observed peaked R waves.

23
Q

For lateral wall infarcts, will observe changes in what leads? (4)

Note: you will also see reciprocal changes in inferior leads.

A

I

AVL

V5

V6

24
Q

What type of MI is caused by the occlusion of the left circumflex?

A

lateral wall infarct

25
Q

What is caused by an occlusion of the left anterior descending artery?

A

anterior wall MI

26
Q

In what leads will a left anterior descending infarct be apparent?

A

V1-V6

There will be reciprocal changes in the inferior leads.

27
Q

What results from the occlusion of the right coronary artery?

A

posterior wall MI

28
Q

For what type of MI do the leads not overly and you have to look for reciprocal changes in the anterior leads?

A

posterior wall MI

29
Q

What will you notice in a posterior wall MI, or occlusion of the right coronary artery?

A

ST segment depression and tall R waves, especially in V1

30
Q

What type of MI has a higher risk of later infarction and mortality?

A

Non Q wave MI

Note: It will behave like small, incomplete infarctions.

31
Q

What is angina/ischemia characterized by? (3)

A

EKG is often normal

ST segment depression

T wave inversion

32
Q

If patient already has a condition that affects the ST segment and QRS, it makes diagnosis of an infarct impossible. True or false?

A

true

33
Q

What syndromes make the diagnosis made by an EKG unreliable? (2)

A

LBBB

WPW

Clinical Methods (23 decks)

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