STEMI NSTEMI

Question 1

LCA is visualized as positive ___ leads

Answer 1

I and aVL V5 and V6

these are both LATERAL

I is alone and can look like an L
L is lateral

5 and 6 Lateral

Question 2

which leads are positive in STEMI occlusions of the RCA

Answer 2

II
III
AVF

also known as the
inferior leads
RCA down

Question 3

which leads are seen with positive in the septal portion of LAD

Answer 3

V1 and V2

septal leads

l

Question 4

anterior leads are ____ which correlate with which artery

Answer 4

V3 AND V4

Question 5

elevation in V1-V4

Answer 5

anteroseptal infarct affecting the LAD

Question 6

cardiac enzymes

Answer 6

troponin is good sensitivity and specificity

although other conditions like renal failure and CHF can cause them

high sensitivity for CRP
and CK-MB creatine kinase MB iso enzyme

more useful in certain situations

Question 7

STEMI mngmt

Answer 7

get to the effin cath lab
door to balloon <90 minutes

cardiac monitor 
supplement O2
nitrates
beta blocjer
morphine
aspirin
good IV access

Question 8

risk stratifications

Answer 8

TIMI score

>65 
> 3 CAD risk factors
document CAD 
documented CAD w/ >50% 
ST segment deviation 
>2 anginal episodes in the past 24 hours
ASA use in the past week 
elevation of enzymes 

stratefy
0-2 low

3-4 intermediate

5-7 high risk
**

Question 9

myocardial infarction mimics

Answer 9

benign early repo
pericarditis
brugada

Question 10

what do we see as characterisitc of benign early repo

Answer 10

widespread ST 
notched J point fish hook
tall-T waves in precordial leads
concave ST elevation
no reciprocal changes

Question 11

where would we see the early benign repo

Answer 11

V2-V5

look for the happy face

Question 12

how to tell pericarditis from STEMI

Answer 12

would have ST elevations in all leads except for aVR
and V1

in pericarditis

Question 13

causes of pericarditis

Answer 13

viral infection
trauma
drug induced
post MI (Dresseler’s )

Question 14

signs of pericarditis

Answer 14

pericardial friction rub

possible effusion

Question 15

brugada what is it

Answer 15

inherited channelopathy

with ST elevation and partial RBBB in V1 and V2

Question 16

what is a U wave seen in electrolyte disturbances

Answer 16

repolorization of the purkinje fibers

can be seen fused with a T

Question 17

hypokalemia can transition into

Answer 17

ventricular arrhythmia

Question 18

how low does K for hypokalemia

Answer 18

<3.5 mmol/L

seen on EKG with <2.7

Question 19

why is hyperkal dangerous

what do we see

Answer 19

can still cause cardiac toxicity

peaking of T waves
PR interval prolongation
diminished or absent P
widening of QQRS in sine wave pattern

Question 20

when do we see hyperkalemia on EKG

Answer 20

above 6.5

greater than 9 =ventricular arrhythmias

Question 21

when do we being to see a sine wave

Answer 21

hyper kalemia over 9

Question 22

how do we differentiate BBB from hyperkalemia

Answer 22

bunny ears in V1 and slurred S in V6

vs

hyperkalemia

peaked T everywhere

Question 23

how to reverese hyperkalemia

Answer 23

memebrane stabilizations:
calcium gluconateand hypertonic normal saline

shifters: insulin and albuterol

excreters: sodium bicarboante
furosemide
sodium polystyrene

Question 24

signs of dig toxicity

Answer 24

anorexia 
N/V
visual changes-yellow halo
palpitations
decrease HR

Question 25

what do we see with dig toxicity

Answer 25

ST segment and T wave fused

Question 26

what are the SE of dig

Answer 26

HA weakness seizure drowsiness

Question 27

stable angina

Answer 27

exertional
<20 minutes
same pattern
releived with rest and medication

Question 28

unstable angina

Answer 28

occurs at rest 
>20 minutes
different pattern 
doesn't respond to rest
new onset that limits activity