Three chest pain syndromes and the ECG

Question 1

Name the limb leads, augmented limb leads, and precordial leads

Answer 1

• I-III
• AvF, AvL, AvR
• V1-V6

Question 2

what is effect of myocardial ischemia on ECG

Answer 2

• ST segment depression with or without T wave inversion

Question 3

What is effect of myocardial injury on ecg

Answer 3

• ST elevation with or without loss of R wave

Question 4

what is effect of myocardial infarction on ecg

Answer 4

• DEEP Q waves (no depolarization current from dead tissue

Question 5

Give series of events at muscle leading to heart attack

Answer 5

• myocardial ischemia to myocardial injury to myocardial infarction

Question 6

What is happening to the cardiomyocyte to cause ST segment elevation?

Answer 6

• cellular injury from ischemia reduces your RMP to shorten the duration of the action potential and decrease your rate of rise of phase 0, giving a difference between normal and ischemia areas, giving current of injury

Question 7

how does the mean ST vector relate to epicardial injury

Answer 7

• mean ST Vector points toward area of epicardial injury and away from endocardial injury

ALLOWS for localization by ST elevation

Question 8

what is a good lead to use when looking at ST changes?

Answer 8

• V5, which is sitting more directly to the left ventricle

Question 9

What is shown for MI’s on acute EKG?

Answer 9

• ST elevation

Question 10

What is shown for MI’s hours in for EKG

Answer 10

• ST elevation
• decreased R wave
• q wave begins

Question 11

What happens Day 1-2 post MI for EKG

Answer 11

• T wave inversion
• Q wave deeper
• NO ST elevation

Question 12

Days later – MI — EKG

weeks later?

Answer 12

• ST normalizes, t wave inverted, but weeks later:

- ST and T normal, but q wave persists ( NO ST elevation)

Question 13

Myocardial injuyr results in ST _______

Q waves indicate myocardial _________

Myocardial ischemia results in ST ____________

Answer 13

• elevation
• infarction
• depression

Question 14

With diaphragmatic/inferior infarct, look at ________ leads

Answer 14

• II, III, avF

- if lateral, look at V5/V6

Question 15

with anterior infarcts, look at ______ leads

Answer 15

• I, V2, V3, V4

Question 16

With anterolateral infarcts, look at ________ leads

Answer 16

I, avL, V5 , V6

Question 17

describe pericarditis chest pain

Answer 17

• aggravated by inspiration, relieved by leaning forward, radiates to back and neck

Question 18

describe involvement of tissue in pericarditis, and what that means for the EKG lead findings

Answer 18

• visceral and parietal pericardium

- abnormalities in almost all leads, except for AvR and sometimes v1

Question 19

what is the classical finding for EKG for pericarditis

Answer 19

• ST elevation seen in almost all leads, except for AvR and sometimes v1

Question 20

pericarditis is a problem with________(depolarization/repolarization)?

Answer 20

repolarization

Question 21

what is common clinical presentation of pulmonary embolism?

Answer 21

• chest pain

- dyspnea

Question 22

what is the heart abnormality that occurs with more sever e pulmonary embolisms

Answer 22

• right heart after increased PVR

Question 23

V1 and V2 explore the __________

Answer 23

septum and right ventricle