Module 1 - ECG and IABP monitoring Flashcards
1
Q
Anterior MI - Coronary artery affected - 12 Lead
A
Coronary artery affected - 12 Lead
LAD V3, V4
2
Q
Inferior MI - Coronary artery affected - 12 Lead
A
Coronary artery affected - 12 Lead
RCA II, III, aVF
3
Q
Lateral MI - Coronary artery affected - 12 Lead
A
Coronary artery affected - 12 Lead
LCX I, aVL, V5, V6
4
Q
Septal MI - Coronary artery affected - 12 Lead
A
Coronary artery affected - 12 Lead
LAD V1, V2
5
Q
Posterior MI - Coronary artery affected - 12 Lead
A
Coronary artery affected - 12 Lead
LCX or RCA V1 - V4, ST depression, tall R-wave progression
6
Q
Coronary Circulation
A
Consists of R&L Coronary Arteries that arise from the coronary ostia at the aortic root.
Fills during Ventricular Diastole
7
Q
Left main coronary artery
A
Branches into LAD & LCX
8
Q
LAD supplies
A
Supplies:
the Anterior surface of the heart
the anterior 2/3 of the septum
and part of the lateral wall
9
Q
LCX supplies
A
Primarily supplies lateral wall of LV
10
Q
RCA supplies
A
Supplies:
RA
RV
Inferior and posterior walls of the LV
11
Q
Leads V1-V6 are also known as
A
Chest leads
precordial leads
unipolar leads
12
Q
Leads V1-V6 view heart on what plane
A
Horizontal plane
13
Q
I, II, II leads are also known as
A
Limb leads
bi-polar leads
14
Q
aVL, aVR, aVF are also known as
A
Augmented leads
15
Q
The augmented leads view the heart from what plane
A
Vertical plane
16
Q
Most common lead used for transport
A
Lead II
17
Q
The J Point
A
area where S wave changes direction
can be used to determine: ST depression/elevation, and/or QRS duration
18
Q
Delta wave
A
associated with WPW
19
Q
Osborne wave
A
associated with hypothermia
20
Q
Z point is
A
reference point when measuring hemodynamic waveforms
21
Q
[image posterior MI]
A
Posterior MI =
R waves increase,
ST segment depression present in V1-4
Tall R-waves in Right precordium
22
Q
ST changes: ST Elevation is
A
Injury (acute MI)
23
Q
ST changes: ST Depression is
A
Ischemia
24
Q
ST changes: Pathological Q wave
A
Infarction (necrosis) = > 25% of R-wave
25
Q wave significance:
Acute injury = Q wave with ST elevation
Indeterminate = Q wave with ST depression
Old infarction = Q wave without ST changes
26
ST measurement: Limb leads / Precordial leads
Limb/Bi-polar leads : > 1mm above or below in 2 contiguous leads
Precordial/chest/Unipolar : > 2mm above or below in contiguous leads
27
Tented/peaked T waves
> 5mm can indicate Hyperkalemia [image]
28
Flattened T waves / U waves
U waves occur just after the T and are usually smaller than the T wave and can indicate hypokalemia
29
Short PRI
may indicate WPW - delta wave is due to early conduction through the accessory pathway [image]
30
Wide QRS
possible: BBB present, TCA overdose
31
Prolonged QT interval
possible TCA overdose [image]
QT interval measuring R-R interval.
QT interval measuring > 1/2 R-R is prolonged until proven otherwise
32
Salvador Dali's Mustache
DIG DIP - presenting as ST depression; may indicate digitalis toxicity. [image]
33
Pericarditis/Infection on ECG
Diffuse ST elevation on entire ECG in conjunction with PR depression
Presenting with pericardial friction rub or fever [image]
34
Electrical Alternans on ECG
Suspect pericardial effusion/ cardiac tamponade [image]
| R-wave amplitude changes across ECG
35
12 Lead Interpretation
L - lateral wall - I, aVL, V5, V6
I - inferior wall - II, III, aVF
S - septal wall - V1, V2
A - anterior wall - V3, V4
36
3rd degree heart block description
aka: Complete HB, AV disassociation
| QRS interval and P-P interval are regular, but disassociated with each other [image]
37
2nd degree Type I heart block description
aka: 2nd degree AVB, Type I, Mobitz I, or Wenckebach [image]
| R-R is irregular because there is a dropped QRS complex. PRI lengthens until it drops a beat.
38
2nd degree Type II heart block description
aka: 2nd degree AVB, Mobitz II, Type II [image]
| PRI is constant and there are more P waves than QRS complexes. Can be various ratios 2:1, 3:1 etc
39
1st degree Type II heart block description
description [image]
40
What type of injury? [image]
Acute injury is indicated by ST elevation.
41
What type of injury? [image]
Ischemia / Old Infarction / Digitalis Toxicity can present with ST depression
42
Q waves present with ST elevation can indicate [image]
Acute myocardial injury is occurring
43
Q waves present with ST depression or T-wave inversion can indicate [image]
Indeterminate
44
Q waves present without ST changes can indicate [image]
Old injury / Infarction
45
How does paced rhythm appear on ECG?
100% paced rhythms have ventricular spikes present before the QRS [image]
46
[Image] Torsades
Polymorphic V-Tach - Torsades de pointes; can occur with or without a pulse.
47
What is concern with a inferior MI?
Patients presenting with an inferior wall MI may also have a right ventricular MI present which would affect filling pressures. Medications that decrease preload are not recommended, unless the patient has been managed with IV fluids prior to administration. Diagnosis of a right ventricular myocardial infarction (RVMI) can be done by obtaining a right-sided 12-lead ECG. The presence of ST elevation in RV4 is a highly sensitive marker for right ventricular involvement.
Lopez, Orchid Lee (2011-02-15). Back To Basics: Critical Care Transport Certification Review (p. 38). Xlibris. Kindle Edition.
48
Pericardium
Double-walled fibrous sac surrounding the heart
49
3 layers of the hearts myocardium
Epicardium—thin, outermost layer
Myocardium—thick, muscular middle layer
Endocardium—thin, innermost layer
50
Valve order
T-P-M-A (remember Toilet Paper My A$$)
| Tricuspid, pulmonic, mitral, aortic
51
Serum potassium is usually > ____ when ECG changes are present?
7.0
| Normal range of Potassium 3.5 - 5.0
52
[afib with ST elevation image]
Atrial fibrillation with ST elevation. R-R intervals are irregularly irregular with no obvious P waves present.
53
[afib with BBB image]
Atrial fibrillation with bundle branch block. R-R intervals are irregularly irregular with no discernable P waves present.
54
[image 2nd degree type I]
x
55
[image second degree type II]
x
56
[image 1st degree type I]
x
57
[image Complete HB]
x
58
Inferior wall MI is caused by occlusion of which coronary artery?
RCA
59
A patient with hx of TCA OD can exhibit
```
Prolonged QT (>1/2 R-R) [Monitor QTc value > 540]
QRS > 0.12 seconds
```
60
Normal K+ is
3.5-4.5 can be as 5.5 and still be considered normal
61
Atrial Tachycardia is
aka Supraventricular Tachycardia
Narrow QRS
Regular R-R at a rate > 160 bpm
62
IVR is
Idioventricular rhythm -
ventricular rate of 20-40
wide QRS > .120
no P waves
63
AIVR is
Accelerated IVR
ventricular rate of 40-60
wide QRS > .120
no P waves
64
QRS is measured
| A normal QRS is _____ seconds.
measured from beginning of QRS to the J
| Normal QRS is 0.04-0.12 seconds long
65
Diagnosis of a Right sided MI includes
Right sided 12-lead with ST elevation in V4
| Place lead V4 in same spot on right side
66
IABP begins to purge during ascent, this is a reflection of what gas law?
Equipment affected -
Conditions affected -
Boyle's Law -
Expansion of gas - Ascent / Contraction of gas - Descent
Other equipment that may be affected: BP Cuff, ET tube
Other conditions that may be affected: Pneumothorax
67
The balloon for the IABP has dislodged which pulse site is most likely affected?
The L radial is most commonly affected.
Balloon placement in the descending Aorta
Distal tip sits near L subclavian - Decrease/Absent Radial pulse
Proximal end is positioned just above renal arteries - Decrease/Absent urine output
68
What do Rust colored flakes indicate in IABP?
Balloon rupture
69
[Image: IABP EI]
Early Inflation - If greater than 2mm from diacritic notch
70
[Image: IABP LI]
Late Inflation
71
[Image: IABP ED]
Early Deflation
72
[Image: IABP LD]
```
Late Deflation -
if AIDA (Assisted Diastole) > DIA (unassisted diastole)
AIDA < DIA = Normal timing
```
73
The primary trigger for the IABP is the
Patients ECG, using the R wave
74
Timing should always be assessed in a __:__ ratio.
1:2 ratio to compare between assisted and unassisted landmarks
75
IABP's improve hemodynamic effects by
increasing coronary blood flow
| decreasing workload
76
The ______ waveform is used to set and assess timing.
Arterial pressure waveform
77
PAEDP
Patient Aortic End Diastolic Pressure -
| This is patients unassisted diastole
78
PSP
Peak Systolic Pressure -
| This is the patients unassisted systole
79
PDP or DA
Peak Diastolic Pressure or Diastolic Augmentation -
| This is the pressure generated in the aorta as a result of inflation
80
BAEDP
Balloon Aortic End Diastolic Pressure -
This is the lowest pressure produced by deflation of the IAB;
this is Assisted Diastole (ADIA)
81
APSP
Assisted Peak Systolic Pressure -
| this systoles follows ballon deflation and should reflect the decrease in LV work
82
DN
Diacrotic Notch - closure of the aortic valve
83
Balloon inflation occurs at the onset of
Ventricular Diastole -
| Indicated on the Arterial waveform as the diacritic notch.
84
Ballon deflation should occur
at the end of diastole, just prior to the onset of ventricular systole.
85
Late deflation can:
Decrease: Arterial Pressure, Cardiac Output, Ejection Fraction
Increase: Heart Rate, Pulmonary Artery Diastolic pressure, Capillary Wedge Pressures
86
LVAD criteria
Heart Transplant Candidate
demonstrate reversible endstage organ disease
BSA large enough for device
NY Heart Association - Class IV heart failure criteria
Hemodynamic deterioration: CI < 2.0; MAP < 65;
Ability to manage device
87
If IABP fails
cycle balloon every 30 minutes
88
Most lethal IABP timing errors
EI, LD
89
IABP inflates
| IABP deflates
at onset of Ventricular diastole
| at onset of Ventricular systole
