CVPR Week 2: Heart model and ECG Part II

Question 1

Objectives

Answer 1

Question 2

Localization using EKG leads

Answer 2

Question 3

What leads would represent the inferior portion of heart?

Answer 3

II, AVF, III

Question 4

What leads would represent the left portion of the heart?

What leads would represent the inferior portion of heart?

Answer 4

• left: AVL, I
• inferior: II, AVF, III

Question 5

Limb leads vs precordial leads

Answer 5

2D vs 3D

Question 6

Precordial lead placement

Answer 6

V1 - V6

Question 7

V1 lead placement

Answer 7

Question 8

V2 lead placement

Answer 8

Question 9

V3 lead placement

Answer 9

Question 10

V4 lead placement

Answer 10

Question 11

V5 lead placement

Answer 11

Question 12

V6 lead placement

Answer 12

Question 13

How to group EKG leads based on the area of the heart?

Answer 13

SALLI

Question 14

“SALLI”

Answer 14

Septal

Anterior

Lateral

Lateral

Inferior

Question 15

Basic Coronary Artery anatomy

Answer 15

3 main coronary arteries that need to know

• right coronary artery
• Left anterior descending
• Circumflex coronary artery
  *

Question 16

Basic Coronary Artery anatomy branches

Answer 16

3 main coronary arteries that need to know

right coronary artery

Left anterior descending

Circumflex coronary artery

Question 17

3 main Coronary arteries and location

3 listed

Answer 17

Question 18

Identify

Answer 18

Question 19

Right dominant Basic Coronary Artery anatomy

Answer 19

Question 20

Basic Coronary Artery anatomy hemispheric dominance

Answer 20

Question 21

Right dominant coronary artery anatomy diagram

Answer 21

Question 22

Septal Lead localization

Answer 22

V1/V2

Question 23

Anterior Lead localization

Answer 23

V3/V4

Question 24

Lateral Lead localization

Answer 24

V5/V6 - left lateral

I/AVL - left lateral

Question 25

Inferior Lead localization

Answer 25

II/III/AVF

Question 26

V1/V2 represent

Answer 26

Septal

Question 27

V3/V4 represent

Answer 27

Anterior

Question 28

V5/V6 represent

Answer 28

Lateral

Question 29

I/AVL represent

Answer 29

Lateral

Question 30

II/III/AVF represent

Answer 30

inferior

Question 31

Which coronary artery supplies the septal wall?

Answer 31

LAD

Question 32

Which coronary artery supplies the Anterior wall of the left ventricle?

Answer 32

LAD

Question 33

Which coronary artery supplies the lateral wall of the left ventricle?

Answer 33

Circumflex artery

Question 34

Which coronary artery supplies the high lateral wall of the left ventricle?

Answer 34

mostly circumflex but sometimes LAD

Question 35

Which coronary artery supplies the inferior wall of the left ventricle?

Answer 35

Posterior descending artery

Question 36

How do V1 and V2 represent the septum?

Answer 36

Question 37

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Answer 37

Question 38

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Answer 38

Question 39

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Answer 39

Question 40

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Answer 40

Question 41

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Answer 41

Question 42

What can an EKG tell us about blood flow to the heart?

Answer 42

Question 43

What is worse Ischemia, injury (acute) or necrosis

Answer 43

Ischemia \>\>\>\> Injury (acute) \>\>\>\> Necrosis (chronic)

Question 44

What to look at to determine a occlusion to the heart

Answer 44

look at the ST segment and T wave

Question 45

Partial occlusion of a coronary vessel and EKG

Answer 45

**EKG manifestations of partial occlusion DO NOT localize!!!** T wave inversions and ST depression Subendocardial infarct

Question 46

T wave inversions

Answer 46

* significant if deep, new, QRS is upright * typically symmetric * T wave inversions do not always mean ischemia if they are not new, deep, or have been there for awhile

Question 47

ST Depression

Answer 47

Question 48

Complete occlusion of a coronary artery and EKG

Answer 48

transmural infarct = full-thickness infarct

Question 49

transmural infarct AKA

Answer 49

full-thickness infarct

Question 50

Manifestations of a complete coronary artery occlusion

Answer 50

Hyperacute T waves minutes to hours will progress to ST elevation accompanied by Q-Wave when the tissue is dead These do localize

Question 51

Hyperacute T waves

Answer 51

* V2 to V4 on this EKG so this is probably a LAD complete occlusion * only occurs for minutes to an hour

Question 52

ST Elevation

Answer 52

* J point is the junction between the termination of the QRS complex and the beginning of the ST segment * TP segment used as a baseline to compare * What classifies as ST elevation on an EKG 1. New ST elevation at the J point in two contiguous leads of \>0.1 mV in all leads other than leads V2-V3 2. For leads V2-V3 the following cut points apply 3. .2\> mV in men over 40 4. .25mV in men 5. .15 mV in women

Question 53

What area of heart and what vessel?

Answer 53

V2-V6 and I, AVL, so this is probably the Large LAD occlusion so anterior wall and lateral wall

Question 54

Q waves

Answer 54

Question 55

Mechanism of Q waves

Answer 55

caused by septal depolarization

Question 56

Pathologic Q waves

Answer 56

Question 57

Normal vs pathologic Q waves

Answer 57

deep or wide pathologic shallow and skinny probably normal

Question 58

Are there Q waves?

Answer 58

V2-V4 has died

Question 59

Reciprocal changes seen with STEMI

Answer 59

ST depression of the opposite side of the infarct called reciprocal changes most of the time see these changes in the inferior leads if in the anterior

Question 60

Reciprocal changes diagram

Answer 60

infarct in inferior portion will see reciprocal changes in I and AVL

Question 61

Posterior MI

Answer 61

Question 62

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Answer 62

Question 63

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Answer 63

Question 64

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Answer 64

Question 65

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Answer 65

Question 66

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Answer 66

Question 67

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Answer 67