10) 15 Lead part 2 Flashcards by Connor Hancock

(Coronary) left coronary artery supplies:

Left coronary artery 2 major branches are:

= L-ventricle, Intraventricular septum, part of R-ventricle & lower conductive system
= anterior descending artery and the circumflex artery

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1 cause of death when having a MI

is from a lethal dysarrhythmia

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12/15 Lead ECG Kev Approach) 1st.
2nd.

3rd.
4th.

5th.
6th.

7th.

8th

1st} Is there a clear isoelectric baseline? (Skin prep correctly)
2nd} Are QRSs upright leads I, II & III (Check attachment correctly)
3rd} good R wave progression? (Check lead placement)
4th} Is the monitor in the correct mode(diagnostic)? (0.05 to either 40 or 150 Hz)
5th} Is the axis normal? Any axis deviation present?
6th} Is there any ST elevation present? If yes, do you see it in 2 or more contiguous leads?
7th} Is there any ST depression? If yes, do you see it in 2 or
more contiguous leads?
8th} any pathological Q waves present? Yesterday’s news!

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1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:

1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks

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A Lateral Wall high view:
B Left Lateral low view:
C Inferior wall view:
D Septal wall view:
E L-Anterior view:

A= Lead I & aVL= LA
B= Lead 1, aVL, V5 & V6: views LCX & LAD
C= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
D= V1 & V2: Along sternal borders blockages from LAD commonly
E= V3 & V4: left anterior wall : LAD & LMCA blocks

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3 I’S of cardiac) Pathologic Q

Infarction

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3 I’S of cardiac) ST Elevation:

Injury

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A blockage of which of the following would result in the entire left ventricle not receiving blood supply?

Left Main Coronary Artery (LMCA)

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A blockage of which of the following would result in the entire left ventricle not receiving blood supply?

Left Main Coronary Artery (LMCA)

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ECG Camera views) Anterior

Lead V3 V4

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Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view

= Anterior
= Septal
= Inferior
= Lateral

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Congitual:
Reciprocal changes:
Spodicks sign:

= same view leads
= mirrored effect in oppisute/corresponding leads for sure MI
= pericarditis PR slopes down aka STEMI imposter

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ECG Camera views) Left Lateral

Lead I, aVL, V4, V5

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ECG Camera views) Left Lateral

Lead I, aVL, V4, V5

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ECG Camera views) Septal

Lead V1 V2

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ECG Camera views) LMCA - 3 vessel disease

Lead aVR

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ECG Camera views) Posterior

Lead V5 V6

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ECG Camera views) Right

Lead V4R

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ECG Lead coronary arteries) Anterior

(LAD) Left Anterior Descending

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ECG Lead coronary arteries) Inferior

(RCA) Right Coronary Artery

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ECG Lead coronary arteries) Posterior

(RCA) Right Coronary Artery &/or (LCX)

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ECG Lead coronary arteries) Right

(RCA)

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ECG Lead coronary arteries) Lateral

(LCX) Left Circumflex

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ECG Lead coronary arteries) Anterior

(LAD) Left Anterior Descending

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ECG Lead coronary arteries) Inferior

(RCA) Right Coronary Artery

ECG Lead coronary arteries) Posterior

(RCA) Right Coronary Artery &/or (LCX)

ECG Lead coronary arteries) Right

(RCA)

ECG Lead views) Lead aVR

LMCA - 3 vessel disease

ECG Lead views) Lead V5 V6

Posterior

ECG Lead views) Lead V3 V4

ECG Lead views) Lead V1 V2

Septal

ECG Lead views) Lead I, aVL, V4, V5

Left Lateral

ECG Lead views) Lead V4R

Right

ECG Lead views) Lead aVR

LMCA - 3 vessel disease

ECG Lead views) Lead V4R

Right

Isoelectric line: Used for:

= Down 1mV of calibration bar/ line (bottom of cal) = ST seg depress/elevation, Hypertrophy, amplitude

STE leads criteria) Lead aVR Lead aVL Lead aVF

Lead aVR Lead aVL Lead aVF

STE leads criteria) Lead V1 Lead V2 Lead V3

Lead V1 Lead V2 Lead V3

15 leads views) Lead V4 Lead V5 Lead V6

Lead V4 Lead V5 Lead V6

15 leads views) Lead V4R Lead V8 Lead V8

Lead V4R Lead V8 Lead V8

STE leads criteria) Lead V4R Lead V8 Lead V8

Lead V4R Lead V8 Lead V8

15 leads views) Lead V4R Lead V8 Lead V8

Lead V4R Lead V8 Lead V8

Leads 2, 3, aVF reciprocal leads

leads 1, aVL, V1-6

Leads 1, aVL, V1-6 reciprocal leads

2, 3, aVF reciprocal leads

Leads II, III and aVF look at what part of the heart?

Inferior wall (most common blockacke(RCA)

Leads V1 and V2 look at what part of the heart?

Septal (blockages from LAD commonly)

Leads 1, aVL, V5, V6 look at what part of heart:

L-Lateral (low view : views LCX & LAD)

Leads V1 and V2 look at what part of the heart?

Septal (blockages from LAD commonly)

Leads 1, aVL, V5, V6 look at what part of heart:

L-Lateral (low view : views LCX & LAD)

Leads V3 and V4 look at what part of the heart?

L-Anteriorwall (LAD & LMCA blocks)

Precordial Posterior Lead Placement) V8(5) V9(6):

= Mid-Scapular = ½ way in-between the Scapula & Spine

Reciprocal leads:

3 I’S of cardiac) ST depression, Hyperacute or flipped T Wave:

Ischemia

The coronary vessels A&P

coronary vessels receive blood during diastole when the heart relaxes b/c aortic valve leaflets cover the coronary artery openings (ostia) during systole.

Coronary) Right coronary artery (RCA) supplies: Right Coronary arteries' 2 major branches:

= part R-atrium & ventricle, upper part conduction system = posterior descending artery & marginal artery

Coronary) Right coronary artery (RCA) supplies: Right Coronary arteries' 2 major branches:

= part R-atrium & ventricle, upper part conduction system = posterior descending artery & marginal artery

V8 & V9 STEMI criteria:

0.5mm or greater

Which coronary artery feeds the inferior wall of the heart?

Right Coronary Artery (RCA)

Which coronary artery feeds the left lateral wall of the heart?

Left Circumflex (LCX)

Wellen’s wave type A:

Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower Highly specific for for a critical blockage of the LAD

Wellen’s wave type B:

DEEP inverted T waves V2 or V3,

De Winter’s T Waves:

V2 V3 most commonly but can happen any lead ST depression at the J-point & upsloping ST-segments w/ tall, symmetrical T- waves in the precordial leads (LMCA or LAD occlusion) “Hyper T w/ STD”

Spodicks sign:

sloping down P wave into QRS (evidence of pericarditis)

Printz metal angina

Coronary artery spasm usually w/ stimulant (cocaine) & then occlusion arteries

3 Is of cardiac) Ischemia: “Infarct” Injury: Infarction:

= Ischemia: ST depres/, Hyperacute T waves>5chest avf >10 precordial = “Infarct” Injury: ST elevation 50%, = Infarction: old MI; >25% Q or QRS >1SB

RPM: LAC:

RPM: Posterior & Marginal LAC: anterior descending circumflex

ARTsclerosis: ARTHsclerosis:

= harding of arternia = tunica media plaque build up in layers of media & intima pushing & narrowing lumen size,

Most common reason for MI & Stroke

ARTHsclerosis: Scab of artery can break open from intima, Body constricts, hemostasis, blocks blood flow (Asprin biggest helper antiplatelet) (R side of heart only) L side Lungs filters clots)

Bundle Branch A&P) Fascicle of the conduction system: Bundle branch blocks:

= Facilitates syncytium = ventricles out of sync