TEST 3 Flashcards
Chest leads have what type of polarity
V1-V6 = unipolar
Limb leads have what type of polarity
I, II, III, aVR, aVL, aVF = bipolar
Right arm always have what type of charge
NEGATIVE - -
Left arm always has what type of charge
Positive or negative +/-
Left leg always has what type of charge
POSITIVE ++
Electrical impulse always moves towards which pole?
to the positive pole. This causes and upward deflection in the EKG strip
aVR has what type of deflection?
negative
aVL and aVF have what type of deflection?
Positive
Leads I, II, III should have what type of deflection
POSITIVE
V1 AND V2 PLACEMENT
4TH ICS
V4 AND V5 PLACEMENT
5TH ICS
V1-V3 deflection
Going away from so negative with increasing positivity
V4-V6 deflection
Coming toward that lead so positive
What does SAL represent
Septal V1 and V2
Anterior V3 and V4
Lateral V5 and V6
I and aVL represent which area of the heart
high lateral
-V5 and V6 are lateral as well
II, III, and aVF represent which area of the heart
inferior
“boot”, boot them to the Cath lab
V1 - V4 represent which area of the heart
anterior septal
ST depression on EKG is representative of what
Ischemia
inverted T waves represents what
previous damage or previous MI
Q waves represent what
never go away - represent an MI in the past
defined as duration >0.04 or >25% R wave amplitude
Axis Deviation trick
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
Which leads do you look at to determine a BBB
I, V1, V6
RBBB
always a wide QRS
Two QRS out of phase. R and R in right
LBBB
always a wide QRS
Double elevated R wave
Steering wheel method
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
Holter Monitor
ambulatory ekg monitor with continuous EKG for 24-48 hours
Ambulatory Event Monitor
longer than holter
patient triggered or automatic recording with abnormalities
loop recorders can be implanted for up to 2 years
troponin
levels rise within 2-3 hours
only one elevated troponin is needed to dx MI
if no EKG changes are present, NSTEMI
creatinine kinase
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
what does a stress test determine
areas of the heart that have decreased oxygenation with increased contractility and oxygen demand
contraindications to stress test
CHF uncontrolled arrhythmias angina MI PE aortic dissection
patient must be NPO for 4 hours and have IV access
Left side cardiac cath
Looks at vessels, valves, and ejection fraction. Diagnoses cardiovascular disease
interventions can be made- stents, balloons, etcs
Right side cardiac cath
Looks at pressures in the heart, blood flow problems, valve issues, pulmonary hypertension
more diagnostic then interventional
Echocardiogram
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
TEE
Looks at the back of the heart and can see better
can see vegetation
Bubble study
confirms a atrial-septal defect
normal ef
50-80%
new murmur noticed?
order an echo. Best way to see valves and diagnose insufficiency verses regurgitation
Stenosis
valves don’t open properly… back flow is occurring
Aortic Stenosis
causes back flow in to the LV and then lungs
syncope, dyspnea, narrow pulse pressure, arythmias and sudden cardiac death, LV hypertrophy
If can’t do a cardiac cath, options?
CTA - can see calcium plaque on vessels
PET scan
MRA
