EKG ACS highlights

Question 1

ACS pathophys:
1) What is the acute event?
2) What is the chronic event that may begin with exertional angina?

Answer 1

1) Rupture of unstable plaque is the acute and thrombus formation
2) Progression to (near) total occlusion

Question 2

Name 1 component of ACS Dx

Answer 2

EKG changes

Question 3

ECG criteria for ACS: Everything is _____mm (except V2 &V3)

Answer 3

1mm

Question 4

_____ wave changes reflect myocardial ischemia (early ACS)

Answer 4

T

Question 5

Onset of MI = ________________ waves = tall or peaking T waves (nearly same as QRS in same lead)

Answer 5

hyperacute T

Question 6

When do T waves invert?

Answer 6

Few minutes to hours after onset MI

Question 7

What is an important characteristic of T wave inversion from ischemia?

Answer 7

Symmetric

Question 8

Will other causes of T wave inversion by symmetric or asymmetric?

Answer 8

Asymmetric

Question 9

Second change that occurs acutely in evolving STEMI is what?

Answer 9

ST segment elevation

Question 10

STE usually means what?

Answer 10

Myocardial injury

Question 11

Persistent STE often indicates what?

Answer 11

Ventricular aneurysm

Question 12

List some other causes of ST elevation

Answer 12

1) Pericarditis
2) J–Point (junction point) elevation is very common in normal hearts
3) Early repolarization

Question 13

_____________ elevation is very common in normal hearts and has no pathologic significance

Answer 13

J–Point (junction point)

Question 14

True or false: J-Point has no pathologic significance

Answer 14

True

Question 15

________ repolarization, esp. in _________ leads may carry slight increased risk of V-Tach

Answer 15

Early; inferior

Question 16

The____________ is the junction between the end of the QRS complex and the beginning of the ST segment.

Answer 16

J point

Question 17

The________________marks the end of the QRS complex, and is often situated above the baseline, particularly in healthy young males.

Answer 17

J(junction)point

Question 18

Name a genetic condition caused by dysfunctional cardiac Na+ channels

Answer 18

Brugada syndrome

Question 19

What are the guidelines to diagnose a STEMI?

Answer 19

1) Plus, ST elevation must be present in at least 2 contiguous leads
2) Compare to old ECG to see if J-point elevation present or STE is new
3) J-point elevation will not change on serial ECGs – STE evolves as MI evolves

Question 20

To Dx STEMI:
1) _____________ must be present in at least 2 contiguous leads.
2) Compare to old ECG to see if ________________ present or STE is new.
3) J-point elevation will _____ change on serial ECGs; STE evolves as MI evolves

Answer 20

1) ST elevation
2) J-point elevation
3) not

Question 21

Appearance of new ______________ indicate irreversible myocardial cell death and is diagnostic of MI

Answer 21

Q waves

Question 22

New Q waves usually appear within ________________ of onset of STEMI but may take several days to evolve

Answer 22

several hours

Question 23

List 2 reciprocal ECG changes

Answer 23

1) Posterior ST elevation – Anterior ST depression
2) Inferior ST elevation <> Anterior and/or Lateral ST depression

Question 24

Pathologic Q waves are _________ and _________ than normal Q waves

Answer 24

wider and deeper

Question 25

Ignore _________ in evaluating Q waves

Answer 25

aVR

Question 26

What indicates myocardial ischemia and progression? Is this a permanent change if a true MI?

Answer 26

T wave peaks then inverts; T wave may remain inverted for months to years

Question 27

What indicates myocardial injury? Is this a permanent change if a true MI?

Answer 27

Acutely, STE and merges with T wave; STE usually returns to baseline within a few hours

Question 28

What reflect MI? Is this a permanent change if a true MI?

Answer 28

New Q waves appear within hours to days; usually persist for life

Question 29

What does the anterior IV branch (LAD) supply?

Answer 29

Anterior 2/3 septum and anterior wall of the heart

Question 30

True or false: coronary artery anatomy can vary

Answer 30

True

Question 31

What runs between the LA and LV & supplies the lateral wall of the left ventricle?

Answer 31

Circumflex artery

Question 32

Most MIs involve the _______ to some degree

Answer 32

LV (left ventricle)

Question 33

List 3 characteristics of pathologic Q waves

Answer 33

1) 0.04 duration 2) > 25% of R wave 3) Contiguous leads

Question 34

Anterior MI does not always result in Q waves….may just be loss of R wave progression from _________ thru _________

Answer 34

V1 thru V5

Question 35

Anterior MI does not always result in Q waves….may just be loss of R wave progression from V1 thru V5; explain how this is seen on EKG

Answer 35

By V4 R>S wave R wave in V3 is not larger than 3 mV

Question 36

What are 2 special T wave abnormalities that might signal Anterior MI from occlusion of Ant IV septal branch of LCA?

Answer 36

1) de Winter’s T waves 2) Wellens’ waves

Question 37

What is equivalent to ST elevation?

Answer 37

DeWinter's T waves

Question 38

Wellens' waves: Deeply inverted or biphasic T waves in leads V2-4 predict what?

Answer 38

Proximal occlusion of the anterior IV branch of LCA (LAD) (cause for concern)

Question 39

What is most often misdiagnosed, especially if occurs in isolation?

Answer 39

Posterior infarct (In isolation 10% of time)

Question 40

Posterior infarct: 1) Diagnosis requires finding reciprocal lead changes in the __________ leads 2) Give 2 examples of these reciprocal changes

Answer 40

1) anterior 2) ST depression and Tall R waves in anterior leads

Question 41

If ______________ occurs with inferior MI, then should see inferior MI with STE in inferior leads

Answer 41

posterior infarct

Question 42

Posterior infarct: 1) Describe normal QRS in V1 2) Describe reciprocal QRS in V1

Answer 42

1) Small R wave and deep S wave 2) Tall R wave > S wave, + ST depression = highly suggestive of posterior MI

Question 43

Posterior infarct: What deviation is seen here?

Answer 43

Don’t confuse with RVH; also see RAD (reciprocal QRS in V1)

Question 44

List 2 characteristics that could be seen in anterior infarct

Answer 44

ST elevation V2-3 Poor R wave progression

Question 45

List 2 characteristics that could be seen in inferoposterior MI

Answer 45

Inferior lead STE V1 with tall R wave, ST depression and T wave inversion

Question 46

List 2 important characteristics of NSTEMI

Answer 46

1) No ST elevation or Q wave formation 2) Localized just like STEMI except - EKG changes are T wave inversion and ST depression

Question 47

Takotsubo cardiomyopathy: Closely mimic acute STEMI with ______________ and ______________

Answer 47

T wave inversion and ST elevation

Question 48

What occurs most often postmenopausal women, under extreme psychological or emotional stress?

Answer 48

Takotsubo cardiomyopathy

Question 49

"Apical ballooning syndrome” may occur with what?

Answer 49

Takotsubo cardiomyopathy

Question 50

Troponins are within normal limits set by laboratory with what?

Answer 50

Stable or unstable angina

Question 51

What is Prinzmetal angina?

Answer 51

Angina + ST elevation

Question 52

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Question 53

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Question 54

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