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EKG > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

ischemia

A
  • deprivation of oxygen and nutrients to myocardium
  • heart needs more oxygen than arteries can deliver
  • causes- exs, tachycardia, hypotension, anemia
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2
Q

angina

A
  • chest pain resulting from diminished BF to a region of the heart
  • due to CAD or coronary spasm
  • stable or unstable
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3
Q

stable angina

A
  • exs induced

- predictable

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4
Q

unstable angina

A
  • pain at rest

- if exertional angina is getting worse considered unstable

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5
Q

acute coronary syndrome (ACS)

A
  • unstable CAD or evolving infacrtion
  • STEMI
  • nSTEMI
  • unstable angina
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6
Q

classic presentation of MI

A
  • prolonged ( >20 min) crushing sub-sternal chest pain
  • pain radiates to L arm, jaw, or shoulder
  • associated with nausea, diaphoresis, SOB
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7
Q

EKG during MI

A
  • initial EKG may not always be diagnostic
  • evolution of EKG varies person to person
  • impt to obtain serial EKGs
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8
Q

stages of STEMI

A
  • transient T wave changes happen immediately (T wave peaking and inversion)
  • ST segment elevation 0-24 hours
  • pathologic Q waves within hours to days (permanent)
  • T wave inversion- within hours to days and often normalize
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9
Q

pseudonormalization vs normalization of T waves

A
  • pseduo- pt has chronic T wave inversions which normalize in setting of chronic ischemia
  • normalization- T waves invert due to ischemia eventually return
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10
Q

ST elevation

A
  • myocardial injury beyond ischemia

- potentially reversible if perfusion occurs soon enough

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11
Q

reciprocal changes during MI

A
  • a distant lead from infarct may record ST segment depression
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12
Q

Inferior infarction

A
  • RAD

- Leads II, III, and aVF

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13
Q

Lateral infarction

A
  • left circumflex a

- in leads I, aVL, V5 and V6

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14
Q

anterior infarction

A
  • LAD
  • “widow maker”
  • leads V1-V4
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15
Q

posterior infarction

A
  • occlusion of RCA
  • reciprocal changes in anterior leads
  • often missed because you do not see the ST elevation only depressions
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16
Q

treatment for STEMI

A
  • urgent reperfusion therapy
  • door to balloon time <90 min
  • aspirin
  • oxygen only when hypoxic
  • sublingual nitroglycerin to treat chest pain
  • morphine to treat chest pain
  • beta blockers within 24 hours
17
Q

hyperkalemia

A
  • due to renal disease, adrenal insufficiency, and meds
  • meds: ACEI, angiotensin receptor blockers, K sparing diuretics
  • EKG finding- peaked T waves, may develop sine wave
  • can lead to v fib
18
Q

hypokalemia

A
  • dietary deficiency
  • alkalosis
  • excess mineralocorticoids
  • meds- diuretics
  • presents with T wave flattening and sometimes U wave
19
Q

hypocalcemia

A
  • malabsorption
  • vit D def
  • hypoparathyroidism
  • EKG findings- T wave flattening, prolonged QT, shortened PR
  • increased risk of torsades
20
Q

R on T phenomenon

A
  • occurs due to hypocalcemia

- R wave forms at same time as T is forming

21
Q

hypercalemia

A
  • malignancy
  • granulomatous disease
  • medication induced
  • primary hyperparathyroidism
  • EKG findings- shorted QT interval
22
Q

hypothermia

A
  • metabolism slows
  • sinus bradycardia
  • segments and intervals prolong
  • distinct ST elevation called osborne wave
  • arrhythmias develop, usually slow a fib
23
Q

digitalis effect

A
  • slows down AV node conduction
  • occurs at therapeutic levels
  • ST depression with gradual downslope
  • T wave flattening or inversion
  • expected and does not necessitate d/c of drug
24
Q

digitalis toxicity

A
  • occurs at supratherapeutic levels
  • sinus node suppression -> sinus exit block
  • AV conduction blocks 1-3rd degree
  • tachyarrhythmias
  • most common= paroxysmal atrial tachycardia
25
Q

paroxysmal atrial tachycardia (PAT)

A
  • from ectopic focus or reentrant circuit
  • usually cannot distinguish from SVT
  • have P waves hiding behind T waves
  • rate usually 100-200
26
Q

acute pericarditis

A
  • often post viral infection
  • pt presents with sharp chest pain
  • EKG shows diffuse ST elevation, T wave changes, and PR depressions in multiple leads
  • usually self limited
  • associated with pericardial effusions
  • tx- NSAIDs
27
Q

pericardial effusions

A
  • low voltage because harder for electrical energy to make through fluid
  • heart rotates freely within fluid filled sac -> varied amplitude of waveforms called electrical alternans
28
Q

COPD

A
  • low voltage
  • R axis deviation
  • poor R wave progression
  • R atrial enlargement
29
Q

acute PE

A
  • right ventricular hypertrophy or dilation
  • RBBB
  • S1, Q3, T3
  • tachycardia (sinus or a fib)
30
Q

S1, Q3, T3

A
  • occurs in acute PE
  • large S in I
  • Q wave in III
  • inverted T wave in III
31
Q

brugada syndrome

A
  • rare
  • inherited autosomal dominant train
  • most common in men in 20s and 30s
  • pt presents with syncope
  • EKG shows RBBB and ST elevation in V1 V2 and V3
  • risk of V tach -> sudden death

EKG (4 decks)

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