STEMI NSTEMI Flashcards
LCA is visualized as positive ___ leads
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
which leads are positive in STEMI occlusions of the RCA
II
III
AVF
also known as the
inferior leads
RCA down
which leads are seen with positive in the septal portion of LAD
V1 and V2
septal leads
l
anterior leads are ____ which correlate with which artery
V3 AND V4
elevation in V1-V4
anteroseptal infarct affecting the LAD
cardiac enzymes
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
STEMI mngmt
get to the effin cath lab
door to balloon <90 minutes
cardiac monitor supplement O2 nitrates beta blocjer morphine aspirin good IV access
risk stratifications
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
**
myocardial infarction mimics
benign early repo
pericarditis
brugada
what do we see as characterisitc of benign early repo
widespread ST notched J point fish hook tall-T waves in precordial leads concave ST elevation no reciprocal changes
where would we see the early benign repo
V2-V5
look for the happy face
how to tell pericarditis from STEMI
would have ST elevations in all leads except for aVR
and V1
in pericarditis
causes of pericarditis
viral infection
trauma
drug induced
post MI (Dresseler’s )
signs of pericarditis
pericardial friction rub
possible effusion
brugada what is it
inherited channelopathy
with ST elevation and partial RBBB in V1 and V2
what is a U wave seen in electrolyte disturbances
repolorization of the purkinje fibers
can be seen fused with a T
hypokalemia can transition into
ventricular arrhythmia
how low does K for hypokalemia
<3.5 mmol/L
seen on EKG with <2.7
why is hyperkal dangerous
what do we see
can still cause cardiac toxicity
peaking of T waves
PR interval prolongation
diminished or absent P
widening of QQRS in sine wave pattern
when do we see hyperkalemia on EKG
above 6.5
greater than 9 =ventricular arrhythmias
when do we being to see a sine wave
hyper kalemia over 9
how do we differentiate BBB from hyperkalemia
bunny ears in V1 and slurred S in V6
vs
hyperkalemia
peaked T everywhere
how to reverese hyperkalemia
memebrane stabilizations:
calcium gluconateand hypertonic normal saline
shifters: insulin and albuterol
excreters: sodium bicarboante
furosemide
sodium polystyrene
signs of dig toxicity
anorexia N/V visual changes-yellow halo palpitations decrease HR
what do we see with dig toxicity
ST segment and T wave fused
what are the SE of dig
HA weakness seizure drowsiness
stable angina
exertional
<20 minutes
same pattern
releived with rest and medication
unstable angina
occurs at rest >20 minutes different pattern doesn't respond to rest new onset that limits activity
