9) 15 lead & MI Flashcards by Connor Hancock

aVR:
Lead Sensitivity & Specificity:

augmented voltage right} HUGE!!!
= Sensitivity 80% & Specificity 95%

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Nitro) Women typically take boner pills for :
Other reasons for taking Boner pills:
Boner pills name & Common prescribed:

= Pulmonary hypertension
= Hypertrophic prostate problems
= phosphodiesterase-5 (PDE5) inhibitors} sildenafil (Viagra) and tadalafil (Cialis)

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Right inferior wall MI:
STEMI produced w/ MIs:
OMI:
RIGHT VENTRICULAR INFARCT (RVI):

= most common MI up to 50% w/ RVI & 5-6% only RVI
= 50% MIs
= occlusion MI in coronary arteries
= Isolated RVIs don’t occur to frequent

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ECG change represents active myocardial injury:

ST-Segment Elevation

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Sides of heart w/ MI dif/s

= Rs-heart < M. so drowns w/ MIs & L-side can still pump bc more M.

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Coronary Artery Occlusion Data) CP w/ exertion % narrowing:
Chest Pain at rest have % occlusion:
Chest Pain not relieved by nitro % occlusion:

= 70-85% narrowing
= 90% occlusion
= 100% occlusion w/ clot!!

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Which of the following ECG changes represents myocardial ischemia:

Hyperacute T-Waves

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Blue dots:

= (electrode) have 5 lil dots for abrading skin, run finger around white NEVER BLUE PART

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15 lead) Skin prep: dry wet skin, shave/clip, Gently abrade dead skin (skin prep tape) 3m red dot skin sandpaper
MCL:

= dry wet skin, shave/clip, Gently abrade dead skin (skin prep tape) 3m red dot skin sandpaper
= MCL “12 lead w/o 12lead cables”

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1 Multi-Lead ECG (9-Lead) Monitor’s ECG:

2 Auto-trending:
3 Auto-trending prints outside timeframe if:
4 Non diagnostic:
5 Setting Changes for diagnostic:
6 Intervals:

= “Just know where + is for views” Standard 12 lead: 1,2,3 then aVR, aVL, AVF then V1,2,3 then V4,5,6
= Computer Pulls best 2.5 secs for each lead from 9-10secs
= computer will spit out paper when keeping 12 lead on
= ** STEMI or Bisificular block ** ~95-96%
= clean 12 lead}Age important (F or M) ESPECIALLY PEDIS
= PR & QRS usually well, QT: calc >0.45 long, P-QRS-T Axes 50

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Standard hospital printout:

All boxes w/ 3 static strips, 6 sec strip 4 lead 2.5 sec 12 lead

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Isoelectric line:
Used for:

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

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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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1 cause of death when having a MI

is from a lethal dysarrhythmia

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Lvls of infarction:
Sub-Endo damage:
Transmural damage:
Infarct damage:

= Endo, transmural, infarct/ Ischemia Injury Infarct
= (Ischemia) Inside wall damaged 1st endocarditis
= (Injury) In-outside hypoxia 50% damage
= (Infarction) all death

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ECG changes represents an old myocardial infarct:

Pathological Q-Waves “Yesterday’s news”

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FMC

First Medical Contact “see STEMI call it in then”

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Sub-Endo damage
Transmural damage

= damage just inside
= like burn full damage

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In setting of ACS) + STE in aVL:
+ STE in V1:
STE in aVR > STE V1:
STE in aVR > 1.0mm

= LMCA occlusion
= LMCA or proximal LAD occlusion
= LMCA occlusion
= should make you worry!!

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AMI Recognition) What to look for
mm criteria in leads
V2 & V3 female criteria:
V2 & V3 <40 Males criteria:
V2 & V3 >40 Males criteria:

= ST seg/ elevation Present in 2 anatomically contiguous leads
= 1mm or > in all leads except V2 & V3
= 1.5 mm or > for females
= 2.5 mm or more for males <40 years of age
= 2 mm or more for males >40 years of age

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!!!aVR–The Forgotten Lead:
Possible ischemic findings:

STE in aVR > STE V1:
STE in aVR > 1.0mm should make you worry!!

= ST-seg elevation (STE) w/ other ischemic findings is BAD!!!
=Widow-maker, LMCA occlusion, proximal LAD occlusion, or triple vessel disease
= LMCA occlusion
= should make you worry!!

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Widow-maker:
w/ PVC in 4 lead:
Inferior MIs expect:

= Full left side infarction from left coronary arteries infarction
= “PVCs put em leads”
= heart blocks & bradycardias (SA & AV aint des)

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Lead Sensitivity:
Lead Specificity:

= how often shows up
= how accurate

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Nitro notes) nitro max admin & before narc:
RS no nitro b/c:
Inferior MIs contraindicate Nitro:

= 3 nitros before giving narc
= RS Preload dependent (frank starling)
= often involve (RCA) supplies blood to (RV) for preload dependency & nitro admin will tank BP

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15 lead) switching leads to back & R: Leads V1-6: If poor progression: Monitor & diagnostic modes: Determining Diagnostic:

= P wave, QRS, T upside-down lead 1 = upright R wave progression increasing amplitude = check placement = Monitor conjoins readings & diagnostic fine line reading = 1-30Hz in bottom

ST seg) J point for measuring ST: 1sb/mm elevation or depression: Measure J point: in short w/ measuring:

= J point for measuring ST (start S end T) = STE & ischemic Damage = Measure against TP seg = Below TP depression above TP elevation

Wellens sign:

biphasic T wave 50% of people not STEMI but having MI

Reciprocal leads:

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

= Anterior = Septal = Inferior = Lateral

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)

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

Inferior wall (most common blockacke(RCA)

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)

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

Left Main Coronary Artery (LMCA)

(T wave) Limb leads Amplitude: Precordial "chest" leads amplitude:

= <5mm in LL = <10mm in precordial

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

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

= Anterior = Septal = Inferior = Lateral

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)

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

Inferior wall (most common blockacke(RCA)

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

V8 & V9 STEMI criteria:

0.5mm or greater

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

Ischemia

15 leads views) Lead I Lead II Lead III

Lead I Lateral Lead II & 3 Inferior

15 leads views) Lead aVR Lead aVL Lead aVF

Lead aVR 4 vessel Lead aVL Lateral Lead aVF inferior

3 I’S of cardiac) ST Elevation:

Injury

15 leads views) Lead V4-6

Lead V4 Anterior Lead V5-6 Lateral

15 leads views) Lead V4R Lead V8-9

Lead V4R Right Lead V8-9 Posterior

3 I’S of cardiac) Pathologic Q

Infarction

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!

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

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

STE leads criteria) Lead I-III

≥ 1mm

STE leads criteria) Lead aVR, aVL, aVF

≥ 1mm

STE leads criteria) Lead V1 Lead V2-3

Lead V1 ≥ 1mm Lead V2-3}≥ 2mm M>40, 2.5mm M<40 1.5 all women

STE leads criteria) Lead V4-6

≥ 1mm

STE leads criteria) Lead V4R Lead V8-9

Lead V4R ≥ 1mm Lead V8-9 ≥ 0.5mm

ECG Camera views) Right

Lead V4R

ECG Camera views) Left Lateral

Lead I, aVL, V4, V5

ECG Camera views) Septal

Lead V1 V2

ECG Camera views) Anterior

Lead V3 V4

ECG Camera views) Posterior

Lead V5 V6

ECG Camera views) LMCA - 3 vessel disease

Lead aVR

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 coronary arteries) Anterior

(LAD) Left Anterior Descending

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 coronary arteries) Lateral

(LCX) Left Circumflex

Coronary) Coronary artery feeds the inferior wall of the heart?

Right Coronary Artery (RCA)

Coronary)coronary artery feeds the left lateral wall of the heart?

Left Circumflex (LCX)

Coronary) blockage of what CA would result in the entire L-ventricle not receiving blood supply?

Left Main Coronary Artery (LMCA)

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

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) 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.

Leads 2, 3, aVF reciprocal leads

leads 1, aVL, V1-6

Leads 1, aVL, V1-6 reciprocal leads

2, 3, aVF reciprocal leads

9) 15 lead & MI Flashcards

(84 cards)