ST segment and hypertrophy Flashcards
what does the ST segment signify
period between ventricular depolarization and repolarization
where is the J point
where the QRS and ST segment meet
in what situations is the J point harder to identify
LVH with strain
early repel
pericarditis
what is considered a normal ST segment
at baseline; smooth transition to t wave
what is considered ST segment changes
> 2mm from baseline in 2 or more leads; can be above or below baseline=abnormal!
flattened ST segment with not much of a wave is also possible pathology
what does ST segment depression indicate
ischemia; NSTEMI
what does ST segment elevation indicate
infact; STEMI
name some benign ST segment changes and whether it would be elevated or depressed
pericarditis-elevation
early repol-elevation
LVH with strain- elevated or depressed
BBB-elevated/depressed
ST segment elevation with upward concavity (esp with notching of the j point) is….
benign
:) happy face
ST segment elevation with downward concavity/ “coving”…
BAD=infarct
:( sad face
how should the T wave normally look
assymetrical
if the t wave looked symmetrical and tall what could this indicate
ischemia/infarct
if the t wave was tall, narrow, peaked, and symmetrical what could this indicate
hyperkalemia
IF THE t wave was broad and wide what could this indicate (plus a wide QRS)
intracranial hemorrhage
what height is considered abnormal for a t wave
> 2/3 height of the R wave
the T wave is normally positive in which leads
I, II, V3-V6
which lead normally has a negative T wave
AvR
if a t wave is flat/inverted in 1 lead this is
benign
if a t wave is flat/inverted in multiple leads this is
pathologic for ischemia
if you have a biphasic T wave and the first part is + this is
benign
if you have a biphasic T wave and the first part is negative this is
pathologic
what are the clinical features of pericarditis
ST segment elevation
notching of the QRS
PR segment depression
what does early repolarization look like
benign ST seg elevation
NO PR segment depression
notching of the QRS
found in young/athletes
for right atrial enlargement what lead should you look at first
lead II
what does lead II show in RAE
> 2.5 mm in height, peaked shaped
think rising right!!
if the p wave in lead V1 is biphasic how can you tell if its RAE
the positive half is taller and wider
if the p wave in lead II is > 0.12 seconds long what is this indicative of
Left atrial enlargement
if you see a M shaped/ camel humped p wave in lead II what is this indicative of
LAE
how will the p wave look in V1 if there is LAE
biphasic wave with the - wave being wide (at least 1 small box) and deep
how does biatrial enlargement appear
MIXED criteria of both LAE and RAE
what are the 2 causes of LVH
increased pressure- HTN, AS
increased volume- AI, MR
how can LVH with strain confuse you for ischemia
ST segment and t wave inversion is normal part of strain - not having an MI
what is the criteria for diagnosis of LVH
the deepest S wave in leads V1/V2 + tallest R wave in V5/V6 = > 35 mm
when can the criteria for LVH not be used
in the presence of LBBB, WPW, ventricular rhythms, e- disturbances, drug effects
BASICALLYYYY anything that effs with the QRS complex shape
if the R wave in AvL is > 11mm what is this indicative of
LVH
monomorphic S waves in I and V6 are indicative of what
LBBB
ST depression and inverted t waves
ischemia
ST elevation with or without t waves
infarct
what is the normal limit of ST segment elevation before it is pathology
1mm in limb leads
ST segment that con caves up is ….
strain
infarct
very broad t waves is significant of
CNS events
stroke
intracranial hemorrhage
if the t wave is >2/3 the height of the R wave this is
pathology
if a t wave is flat this is
pathology
a tall peaked t wave in the precordial leads
hyperkalemia
hyperkalemia can lead to what
IVCD: Right and left BBB
what is the criteria for RVH with strain
RAE RAD RVH ST depression concave down inverted t wave
S1Q3T3
S1Q3T3 is the pneumonic for what
PE
T/F: ST elevation/depression if flat, is usually ischemia
TRRUUUE DAT
what is the LVH with strain pattern
ST elevation concave upward in leads V1-V3 and ST depression concave downward in V4-V6
what is the criteria for RVH
in lead V1 the R:S ratio is >1:1
if you see concordance with a BBB this is significant for
ischemia concerning for infarct
flat t waves signify
ischemia
infarct
inverted t waves signify
ischemia
infarct
strain
new LBBB with cardiac sx is considered
an MI equivalent
describe the carousel pony of a posterior wall MI
in V1/V2 you see ST depression, a big fat tall R wave, and an UPRIGHT t wave
when you see an inferior wall MI what else should you check for
right wall MI
posterior wall MI
if you saw a carousel pony how could you distinguish it from RVH with strain
RVH with strain has an INVERTED t wave whereas pony has an upright t wave
if there is an MI in the lateral wall where would the reciprocal changes be seen
Inferior leads
which coronary artery supplies the anterior, lateral, and septal part of the heart
LAD
what is the first sign of an MI progression
t wave inverts
then the ST segment depresses, ST elevates, q waves
downward sloping ST depression in AvL is indicative of what
inferior wall MI
criteria for an RVI
ST segment elevation in III > than that in II
IWMI
which artery supplies the inferior wall and RV
RCA
true or false: anteroseptal MI’s have reciprocal changes
false; we cannot see the posterior wall
when you have a LWMI where are the reciprocal changes seen
inferior leads shows ST depression
anteroseptal MI with lateral extension is caused by the blockage of which coronary A
LAD
AMIs can cause
AV blocks
BBB
arhythmias
if you have an Apical MI what area is involved
I, II, III, AVF, AVL, V2-V6
inferior, lateral, anterior
an apical MI is caused by the blockage of what artery
RCA
when you see ST elevation in I and II you should think its….
pericarditis
APICAL MI!!
aortic dissection with global infarct
when you see an inferior wall MI you should…
order right and posterior leads!! think PWMI and RVMI
which leads should you look at to check for a posterior wall MI
V1 and V2
