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671A - Anesthesia I > Week 3 - Advanced EKG > Flashcards

Week 3 - Advanced EKG Flashcards

1
Q

3 key factors that determine left ventricular myocardial oxygen demands

A

HR, strength of contraction, systolic pressure developed in the main pumping chamber

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2
Q

What does a subendocardial infarct look like and what EKG changes would be present?

A

Inner part of LV, ST depression

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3
Q

What part of the heart does the RCA supply blood to?

A

Inferior/RV

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4
Q

What part of the heart does the left circumflex supply?

A

Lateral wall of the left ventricle

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5
Q

What part of the heart does the LAD supply?

A

Ventricular septum and a large part of the ventricular free wall

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6
Q

The acute phase of a STEMI is marked by the appearance of ST segment _________ and tall __________ T waves

A

Elevation, peaked

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7
Q

What are reciprocal ST depressions?

A

ST depressions in leads directed 180 degrees from those showing ST elevations.

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8
Q

What is the evolving phase characterized by in a STEMI?

A

Deep T wave inversions.

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9
Q

What part of the heart does an anterior infarct effect?

A

Anterior or lateral wall of the ventricle

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10
Q

Why does ST elevation occur in serve ischemia?

A

Alters the balance of electrical charges across the myocardial cell membranes.

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11
Q

What are the earliest signs of an infarct?

A

ST elevations (and reciprocal ST depressions). Generally seen within mins of blood flow occlusion

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12
Q

If a patient complains of persistent chest pain, and the EKG you have just drawn doesn’t show any indications of an MI, what should you do next?

A

Obtain EKGs in 5-10 minute intervals

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13
Q

A Q wave in any lead indicates that the electrical voltages are directed ________ from that particular lead

A

away

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14
Q

Why do Q waves, in the appropriate context, signify an MI?

A

They signify the loss of positive electrical currents, which is caused by the dead heart muscles.

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15
Q

What is a key feature in anterior wall Q wave infarcts?

A

The loss of the normal R wave progression. Anterior infarcts disrupt this process by causing pathologic Q waves in (V1-V5 or V6) one or more of the precordial leads.

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16
Q

In what direction is the ventricular septum depolarized?

A

right <— left

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17
Q

Anteroseptal infarct is characterized by?

A

ST elevation/pathologic Q waves in leads V1-V4
Loss of R waves in V1-V3. (Generally suggests the LAD is occluded)

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18
Q

In a high lateral infarct, what leads would you suspect to show pathologic Q waves?

A

Leads I and aVL

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19
Q

You may see tall R waves and ST depressions in leads V1-V2, suggesting

A

Posterior infarct.
(Generally leads V7-V9 are added on the patients back to visualize this area more clearly. You would see pathological q waves in these back leads, reciprocal to the tall r waves in leads V1-V2)

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20
Q

Inferior infarcts generally have ________ ventricular involvement

A

right

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21
Q

What may persistent ST segment elevations months - years after an MI indicate?

A

Ventricular aneurysm

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22
Q

Difference between septal q waves and pathologic Q waves

A

Septal q waves are narrow and of low amplitude (less than .04 seconds in duration)
Pathologic Q waves are longer than .04 secs in lead I, all inferior leads, or leads V3-V6

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23
Q

Non-infarction Q waves may be present in which two diseases?

A

Hypertrophic cardiomyopathy and dilated cardiomyopathy

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24
Q

What 3 things can come from a ventricular aneurysm?

A

May lead to chronic HF, can cause ventricular arrhythmias, and may serve as a substrate for clot formation.

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25
Q

In what BBB does the diagnosis of an MI become far more complicated?

A

LBBB (These blocks already present with features resembling an MI)

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26
Q

Most STEMI events are due to

A

Ruptured or eroded atherosclerotic plaque leading to ischemia and infarction.

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27
Q

In many cases, ST segment _________ is shown more frequently in myocardial ischemia (with or without infarction)

A

Depression

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28
Q

________ is a common symptom in coronary artery disease

A

Angina

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29
Q

3 things that can initiate angina

A

Physical exertion, emotional stressors, or exposure to cold

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30
Q

Many, but not all, EKG patterns of patients experiencing acute angina show _____ ______________

A

ST depression

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31
Q

Many patients experiencing transmural (epicardial) injury show ST segment ___________

A

Elevation

32
Q

ST depression is classified as

A

Horizontal or downward ST depressions of at least 1mm in amplitude, lasting .08 seconds or more

33
Q

The major EKG changes with non-Q wave infarctions are

A

ST depressions and/or T wave inversions

34
Q

Prinzmetal’s variant angina is associated with ST __________

A

elevations

35
Q

Why is angina harmful to the heart?

A

Spasms and constriction of the coronary arteries can cause non-infarct ischemia leading to eventual MI

36
Q

Sometimes, ST elevation can be a benign variant caused by

A

Early repolarization –> These elevations DO NOT change and do not show reciprocal ST depression

37
Q

Wellen’s syndrome is classified by

A

Deep T wave inversions, with minimal to no ST elevations.
Caused by a tight stenosis (blockade) in the LAD

38
Q

T wave inversions in only the right chest leads or only the left chest leads may indicate?

A

Right leads –> RV overload
Left leads –> LV overload

39
Q

3 examples of Mechanical/structural complications of the heart

A

HF, cardiogenic shock, LV aneurysm …

40
Q

Electrical complications of the heart include

A

Any type of arrhythmia or block

41
Q

Most effective method to achieve coronary reperfusion

A

Acute percutaneous coronary interventions via angioplasty/stenting. More efficacious than thrombolysis therapy.

42
Q

Most common arrhythmia indicating coronary reperfusion

A

Accelerated idioventricular (AIVR)

43
Q

Axis deviation for positive leads I, II, and aVF

A

NAD

44
Q

Axis deviation for positive lead I, negative lead II

A

LAD

45
Q

Axis deviation for positive lead aVF, negative lead I

A

RAD

46
Q

Axis deviation for negative leads I and aVF

A

Extreme axis deviation

47
Q

Which diseases would you see left axis deviation?

A

LAFB, LBB, LVH, V-pacing, inferior wall MI, WPW

48
Q

In which individuals can LAD be a normal variant?

A

Obese patients

49
Q

What do you expect to show on an EKG with a patient with a LBBB?

A

Terminal R waves in lateral leads (usually broad) –> V5, V6

Which ever way the R or S wave is, T wave is opposite.

50
Q

Incomplete vs complete LBBB?

A

Complete –> QRS longer than .12
Incomplete –> QRS in between .10-.12, all other indications of LBBB

51
Q

What do you expect to show on an EKG with a patient with a RBBB?

A

Terminal R waves in right leads (usually broad) –> V1, V2

Which ever way the R or S wave is, T wave is opposite.

52
Q

What are the two hemiblocks?

A

LAFB –> Most common, left axis deviation
LPFB –> Rare, right axis deviation

53
Q

What happens when you have a LAFB with a RBBB?

A

WIDE QRS. Only the Left Posterior branch is functioning! Grab a pacemaker!

54
Q

Normal QTc

A

350-440 msec

55
Q

Inferior RCA infarction involves the __________ __________

A

Nodal cells (SA node) Get pacer

Variants among patients
85-90% RCA
15-10% LCx

56
Q

Reciprocal changes can be ____________ of an MI

A

confirmation

57
Q

STEMI criteria
New _______ __________ at the J point (QRS endpoint) in two contiguous leads of > ________ mV in all leads except V2-V3

A

ST elevation, 0.1

58
Q

STEMI criteria
For leads V2-V3: Greater or equal to ________ mV in men _______ or older

A

0.2 mV, 40

59
Q

STEMI criteria
For leads V2-V3: Greater or equal to ________ mV in men or greater or equal to ________ mV in women younger than __________

A

0.25 mV, 0.15 mV, 40

60
Q

ST depression is considered significant when ____ - ____ mm from the QRS

A

2-3 mm or 0.2 - 0.3 mV

61
Q

The normal T wave is usually in the _______ _________ as the QRS

A

same direction

62
Q

A normal ECG shows an upright t wave in leads ____, _____, and _____ - _____

A

I, II, V3 - V6

63
Q

A normal ECG shows an inverted T wave in lead ______

A

aVR

64
Q

The QT interval is dependent upon _______ ________

A

heart rate

65
Q

What is Bazett’s formula?

A

Allows you to find QTc
QT / square root of (R - R interval)

66
Q

What is the average direction of ventricular activation in the frontal plane referring to?

A

QRS axis determination

67
Q

What 2 things can QRS axis determination tell us?

A

Changes in sequence of ventricular activation and myocardial damage

68
Q

What degrees does a normal axis pathway fall into?

A

-30 to 90

69
Q

What individuals can have RAD and it be considered a normal variant?

A

Marfans, tall, thin and small framed individuals

70
Q

Which diseases will you see RAD in?

A

LPFB, lateral/anterior MI, RVH, PE, COPD, WPW, atrophy of LV

71
Q

You will see poor R wave progression in V1-V3 in which block?

A

LBBB

72
Q

Hemiblocks usually have normal QRS intervals, when would these complexes be more wide? (longer than 0.12 secs)

A

If there is a coexisting RBBB

73
Q

LAD and branches supply blood to?

A

Anterior and anterolateral walls of the LV, and anterior 2/3 of the septum.

74
Q

What does it mean if a patient is showing more and more leads experiencing ST elevation and pathologic Q waves?

A

The bigger the infarct and the poorer the prognosis

75
Q

How would you define a pathologic Q waves?

A

Greater than .04 seconds and 25% or more of the amplitude of the R wave

671A - Anesthesia I (22 decks)

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