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NSU AA Denver: Winter 2025 (1st Semester) > 2025 ECG Quiz 5 > Flashcards

2025 ECG Quiz 5 Flashcards

Myocardial Ischemia and Infarction (41 cards)

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1
Q

WHAT IS MYOCARDIAL
INFARCTION

A

Occlusion of coronary arteries = acute
coronary syndrome
* Causes myocardial hypoperfusion resulting in
cellular death

AKA: “Heart attack”

May lead to:
* Arrhythmias
* Heart failure
* Cardiogenic shock
* Heart rupture
* Cardiac arrest
* Death

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2
Q

WHAT CAUSES
MYOCARDIAL INFARCTION

A

Coronary Artery Disease
* Narrowing caused by build up of plaque (atherosclerosis)

Coronary Thrombosis
* Blood clot blockage.
* Commonly associated with
coronary narrowing due to
atherosclerosis.

Coronary Artery Spasm
* Cocaine, stress, cold, etc.

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3
Q

ACUTE CORONARY
SYNDROME

A

Any condition brought on by a sudden reduction or
blockage of blood flow to the heart

Stable angina vs Unstable
angina

NSTEMI vs STEMI

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4
Q

STABLE VS UNSTABLE
ANGINA

A

Stable angina: vessel unable
to dilate enough to allow
adequate blood flow

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5
Q

STABLE VS UNSTABLE
ANGINA

A

Unstable angina: Thrombus
forms on ruptured plaque
causing partial occlusion

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6
Q

NSTEMI VS STEMI

A

Non-STEMI
* Partial occlusion
* Cellular death occurs in
subendocardial tissue

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7
Q

NSTEMI VS STEMI

A

STEMI
* Total occlusion
* True emergency
* Cellular death occurs
throughout entire wall of
heart, or transmural

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8
Q

3 COMPONENTS OF MI
DIAGNOSIS

A

History and physical exam

Cardiac enzymes

ECG changes

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9
Q

HISTORY AND PHYSICAL
EXAM

A

Prolonged, severe chest pain
* Classic symptom of cardiac ischemia
* Diffuse chest pain
* May radiate to jaw, neck, left arm, back
* Angina: ischemic chest pain
* Generalized weakness
* Lightheadedness and syncope
* Shortness of breath
* Diaphoresis and pallor
* Nausea and vomiting
* Anxiety/”feeling of impending doom”

Woman and Diabetics can show Atypical signs… dont see the crushing chest pain

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10
Q

CARDIAC ENZYMES

A

Troponin (TnI, TnT)
* Most important cardiac marker
* High sensitivity and specificity
* Rises early and stays elevated
longer than other enzymes
* Valuable for early/late detection
* Provides information pertaining to
acute MI severity and reperfusion

Myoglobin
* Limited specificity, but
high sensitivity makes it
useful for early
detection.

Creatine kinase MB isoenzyme (CKMB)
* High sensitivity & specificity = valuable in assessment of AMI severity & reperfusion
* Limited value early/late

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11
Q

ELECTROCARDIOGRAM

A

During an AMI, the ECG evolves
through 3 stages:
* T wave peaking followed by T wave inversion
* ST segment elevation
* Appearance of new Q waves
* Changes begin immediately after
infarct.
* 12-lead EKG can help aid in localization of infarct.

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12
Q

TREATMENT OF MI

A

THROMBINS2
* Thienopyridines,P2Y12 receptor blockers
* Heparin/enoxaparin, Reninangiotensin
system blockers
* Oxygen
* Morphine
* Beta blocker
* Intervention
* Nitroglycerin
* Statin
* Salicylate (Aspirin)

Management:
* IV Access, ECG, Cardiac
Monitoring, SpO2, CXR
* Send Cardiac Enzyme Labs
* Begin THROMBINS2 if suspected MI from ECG
* Consider revascularization
interventions:
Percutaneous coronary
Intervention (PCI)
Intra-coronary stent (ICS)
Coronary artery bypass graft (CABG)

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13
Q

ST SEGMENT
ELEVATION
MI (STEMI)

A
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14
Q

T WAVE ALTERATIONS

A

1st sign: T waves peak
* Changes due to local hyperkalemia in ischemic myocardium.
* At this point ischemia can be reversible if blood flow is restored promptly
* Must be in two sequential anatomical leads i.e. V1,V2; V5,V6

Hours later: T waves invert
* May persist for months to years.
* Note: T-wave inversion can occur due to causes other than MI. However, in MI, T waves invert symmetrically.

Young kids might have inverted T-Wave normal???

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15
Q

T WAVE ALTERATIONS

A

Young kids might have inverted T-Wave normal???

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16
Q

ST SEGMENT ELEVATION

A
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17
Q

Q WAVE APPEARANCE

18
Q

WHY Q WAVES FORM

Study These Flashcards
A

Myocardium dies and cannot conduct
electrical current.

Electrical forces move away from area of infarction.

Causes deep negative deflection, a Q wave.

19
Q

RECIPROCAL CHANGES

Study These Flashcards
A

Electrical forces move toward sites distant from infarction.

Affect ST segment (depression), Q waves,
and T waves.

20
Q

STEMI SUMMARY

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A

T wave “peaks”

Signifies myocardial ischemia

ST segment elevation; merges with T wave

Signifies myocardial injury

Signifies to baseline within a few hours

T Wave inverts
* Inverts symmetrically
* May resolve or persist for months/years

New Q waves appear

Signifies permanent myocardial
infarction
* Persist for lifetime of patient

21
Q

PEAKED T
WAVES

22
Q

ST SEGMENT
ELEVATION

23
Q

Q WAVE
APPEARANCE

Study These Flashcards
A

Q-Waves can persist for life

24
Q

STEMI-LOCALIZING THE
INFARCT

Study These Flashcards
A

Location of infarct affects prognosis and
treatment.

Two major systems of blood supply to
myocardium:
* Right coronary artery

  • Left coronary artery (left main coronary artery):
  • Left anterior descending artery
  • Left circumflex artery
25
ANATOMICAL CATEGORIES OF INFARCTION
Inferior Lateral Anterior Posterior
26
ANATOMICAL CATEGORIES OF INFARCTION
Inferior Lateral Anterior Posterior
27
LOCALIZING ACS AND INFARCTION
28
INFERIOR INFARCTION
29
LATERAL INFARCTION
30
ANTERIOR INFARCTION
31
POSTERIOR INFARCTION
Since no ECG lead reflects posterior electrical activity, changes are reciprocal of those in anterior leads Can place potentially V7-V9 run along bottom of scapula
32
RIGHT VENTRICULAR INFARCTIONS
33
PRACTICE
V6 - large ST elevation Also in aVF and aVL Lateral infarction
34
PRACTICE
V2 and V3 - ST elevation Peaked T-Waves Anterior infarction
35
PRACTICE
Lead II - ST Elevation Lead I and aVF - small ST Elevation Inferior and Lateral Infarction
36
PRACTICE
Inferior and Lateral Infarction
37
NON-STEMI
More common than STEMIs. NO ST-segment elevation or deep Q waves. Only changes are T-wave inversion and ST depression Usually caused by either: * Nonocclusive thrombosis of major coronary artery * Complete occlusion of small offshoot Involve less than entire thickness of heart muscle Lower initial mortality; higher later re-infarction mortality
38
DISTINGUISHING ANGINA FROM NON-STEMI
EKG findings resemble those of a non- STEMI * ST-segment depression * T-wave inversion Distinction is made by measuring cardiac enzymes: * Significantly elevated with a non- STEMI * Normal with uncomplicated angina
39
Prinzmetal Angina
40
SORTING OUT THE DIFFERENT ISCHEMIC SYNDROMES
41
LIMITATIONS OF THE ECG IN DIAGNOSING INFARCTION
Diagnosis of myocardial infarction with EKG relies on: * T-wave changes * ST-segment changes * Q-wave formation Some underlying cardiac conditions mask these effects: * Wolff–Parkinson–White * Left ventricular hypertrophy * Left bundle branch block... if see on ECG, need to rule out infarction before can do anything (will never show the ST changes)

NSU AA Denver: Winter 2025 (1st Semester) (43 decks)

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