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ECG > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What should you ask yourself about the ST segement?

A

Is it elevated (+ 1.0 mm)?

Is it depressed (-0.5 mm)?

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2
Q

Where should ST elevation/depression be measured?

A

At 80ms past the J-point

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3
Q

What should you consider if you see ST elevation?

A
  1. myocardial infarction
  2. left ventricular aneurysm
  3. pericarditis
  4. prinzmetal’s angina
  5. high take off
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4
Q

What is the evolution of myocardial changes in Q-wave MI?

A
  1. Develop tall T waves
  2. Develop ST segment elevation
  3. ST elevation with T wave inversion
  4. Q wave formation with ST segment inversion
  5. Q wave
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5
Q

Does a normal ECG exclude MI?

A

No -look at ECG and client symptoms

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6
Q

What can an acute MI typically present with?

A

New onset of LBBB

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7
Q

How does angina chest pain differentiate from MI chest pain?

A

MI chest pain is more severe and longer lasting

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8
Q

What are the symptoms of a an MI?

A

Central chest pain, nausea, sweating, vomiting

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9
Q

How long does an episode of angina typically last?

A

2-10 minutes

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10
Q

What causes angina?

A

Discrepancy between oxygen demand of the myocardium and oxygen delivery. Typically caused by CAD and can worsened by thrombus formation and vasospasms.

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11
Q

After how long should angina pain be treated as an MI?

A

20 minutes

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12
Q

What are the 3 pathologic changes of an MI?

A
  1. ischemia
  2. injury
  3. infarction
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13
Q

What is the zone of infarction?

A

The area of death where necrosis has occurred. Scar tissue will form here and the damage is irreversible

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14
Q

What causes pathological Q waves?

A

Zone of infarction. Leads look ‘through’ the non conductive scar tissue.

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15
Q

What is the zone of injury?

A

Surrounds the zone of infarction and results from prolonged lack of oxygen. It shows as ST elevation on ECG.

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16
Q

What is the zone of ischemia?

A

The outermost layer resulting from an interrupted blood supply. It shows as T wave inversion on ECG.

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17
Q

After how many hours during an MI is myocardial necrosis inevitable?

A

6 hours

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18
Q

Do myocardial infarctions cause the same changes in all leads?

A

No characteristic ECG changes that occur with each type of MI are localised to the leads overlying the infarction site.

19
Q

What are reciprocal changes?

A

Opposite changes seen in the leads that are opposite the infarction site.

20
Q

What is a left ventricular aneurysm?

A

Late complication of MI (seen in 10% of survivors)

21
Q

What ECG change does ventricular aneurysm cause?

A

ST segment elevation in the leads that look at that area

22
Q

What are the consequences of left ventricular aneurysm?

A

They are non-contractile and so can lead to myocardial dysfunction and thrombus formation (due to the pooling of blood) and a focus for arrhythmias

23
Q

What are the 4 characteristics of ST elevation of pericarditis?

A
  1. ST elevation is typically wide spread (in all leads that look at the inflamed area)
  2. The ST segment elevation is typically saddle shaped
  3. Q waves do no develop
  4. T wave inversion only happens when ST segement returns to baseline
24
Q

Is pericarditis a contraindication to ECG testing?

A

Yes

25
Q

What leads might you see high take off?

A

Anterior chest leads

26
Q

What is another name for high take off?

A

Early repolarisation

27
Q

What does high take off always follow?

A

A downwards S wave

28
Q

Is high take off associated with reciprocal ST depression?

A

No

29
Q

What’s another name for Prinzmetal’s angina?

A

Vasospastic angina

30
Q

What is vasospastic angina?

A

Reversible chest pain caused by lack of blood supply due to coronary artery spasm

31
Q

When is vasopastic angina most common?

A

In arteries with already underlying CAD

32
Q

In which artery is vasospasm most common?

A

Right coronary artery

33
Q

Lack of which vitamin is associated with vasospastic angina?

A

Magnesium

34
Q

What is the best treatment for vasospasm

A

Calcium channel blockers - not beta-blockers

35
Q

Vasospasm results in hypoxia and therefore what other ECG characteristics?

A

tall t waves/inverted t waves/bundle branch blocks

36
Q

What is normal ST depression?

A

0.5 mm during rest and 1mm during exercise

37
Q

What depression is a stop criteria?

A

2mm depression

38
Q

What should be considered on ST segment depression?

A
  1. myocardial ischemia
  2. acute posterior myocardial infarction
  3. drug toxicity
  4. ventricular hypertrophy with strain
39
Q

What is silent ischemia?

A

lack of oxygen but no chest pain

40
Q

What group of people may suffer from silent ischemia and why?

A

Diabetics due to diabetic neuropathy

41
Q

What is the most common ECG change associated with ischemia?

A

ST depression

42
Q

Do downsloping or upsloping ST segments depression have a better prognosis?

A

Upsloping

43
Q

What type of infarction causes ST segment depression?

A

A posterior MI causes reciprocal depression in leads V1-V3

44
Q

What is LVH/RVH strain characteristics?

A

1) tall/deep S/R waves
2) ST segment depression
3) T wave inversion

ECG (8 decks)

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