TEST 3

Question 1

Chest leads have what type of polarity

Answer 1

V1-V6 = unipolar

Question 2

Limb leads have what type of polarity

Answer 2

I, II, III, aVR, aVL, aVF = bipolar

Question 3

Right arm always have what type of charge

Answer 3

NEGATIVE - -

Question 4

Left arm always has what type of charge

Answer 4

Positive or negative +/-

Question 5

Left leg always has what type of charge

Answer 5

POSITIVE ++

Question 6

Electrical impulse always moves towards which pole?

Answer 6

to the positive pole. This causes and upward deflection in the EKG strip

Question 7

aVR has what type of deflection?

Answer 7

negative

Question 8

aVL and aVF have what type of deflection?

Answer 8

Positive

Question 9

Leads I, II, III should have what type of deflection

Answer 9

POSITIVE

Question 10

V1 AND V2 PLACEMENT

Answer 10

4TH ICS

Question 11

V4 AND V5 PLACEMENT

Answer 11

5TH ICS

Question 12

V1-V3 deflection

Answer 12

Going away from so negative with increasing positivity

Question 13

V4-V6 deflection

Answer 13

Coming toward that lead so positive

Question 14

What does SAL represent

Answer 14

Septal V1 and V2
Anterior V3 and V4
Lateral V5 and V6

Question 15

I and aVL represent which area of the heart

Answer 15

high lateral

-V5 and V6 are lateral as well

Question 16

II, III, and aVF represent which area of the heart

Answer 16

inferior

“boot”, boot them to the Cath lab

Question 17

V1 - V4 represent which area of the heart

Answer 17

anterior septal

Question 18

ST depression on EKG is representative of what

Answer 18

Ischemia

Question 19

inverted T waves represents what

Answer 19

previous damage or previous MI

Question 20

Q waves represent what

Answer 20

never go away - represent an MI in the past

defined as duration >0.04 or >25% R wave amplitude

Question 21

Axis Deviation trick

Answer 21

whichever finger is pointing up is the deviation

if positive deflection, finger up
if negative deflection, finger down

use lead I (lateral) and lead aVF (interior)

both down? no mans land = bundle branch block

Question 22

Which leads do you look at to determine a BBB

Answer 22

I, V1, V6

Question 23

RBBB

Answer 23

always a wide QRS

Two QRS out of phase. R and R in right

Question 24

LBBB

Answer 24

always a wide QRS

Double elevated R wave

Question 25

Steering wheel method

Answer 25

to determine BBB always look at V1 if terminal force is up, flip blinker up, turning RIGHT=RBBB if terminal force is down, flip blinker down, turning LEFT = LBBB

Question 26

Holter Monitor

Answer 26

ambulatory ekg monitor with continuous EKG for 24-48 hours

Question 27

Ambulatory Event Monitor

Answer 27

longer than holter patient triggered or automatic recording with abnormalities loop recorders can be implanted for up to 2 years

Question 28

troponin

Answer 28

levels rise within 2-3 hours only one elevated troponin is needed to dx MI if no EKG changes are present, NSTEMI

Question 29

creatinine kinase

Answer 29

CPK2 or CKMB are specific enzymes for the heart, they take longer to rise (2-4hrs) and peak at 24 hours when ordered usually wanting to determine if it is a cardiac problem

Question 30

what does a stress test determine

Answer 30

areas of the heart that have decreased oxygenation with increased contractility and oxygen demand

Question 31

contraindications to stress test

Answer 31

``` CHF uncontrolled arrhythmias angina MI PE aortic dissection ``` patient must be NPO for 4 hours and have IV access

Question 32

Left side cardiac cath

Answer 32

Looks at vessels, valves, and ejection fraction. Diagnoses cardiovascular disease interventions can be made- stents, balloons, etcs

Question 33

Right side cardiac cath

Answer 33

Looks at pressures in the heart, blood flow problems, valve issues, pulmonary hypertension more diagnostic then interventional

Question 34

Echocardiogram

Answer 34

looks at the inside of the heart - valves, walls, pericardium, cardiac function, regurgitation, insuffiency does not diagnose arthroscleoritc heart disease recommended for long standing hypertension

Question 35

TEE

Answer 35

Looks at the back of the heart and can see better can see vegetation

Question 36

Bubble study

Answer 36

confirms a atrial-septal defect

Question 37

normal ef

Answer 37

50-80%

Question 38

new murmur noticed?

Answer 38

order an echo. Best way to see valves and diagnose insufficiency verses regurgitation

Question 39

Stenosis

Answer 39

valves don't open properly... back flow is occurring

Question 40

Aortic Stenosis

Answer 40

causes back flow in to the LV and then lungs syncope, dyspnea, narrow pulse pressure, arythmias and sudden cardiac death, LV hypertrophy

Question 41

If can't do a cardiac cath, options?

Answer 41

CTA - can see calcium plaque on vessels PET scan MRA