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CC-P Module I ECG and IABP > Module I > Flashcards

Module I Flashcards

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1
Q

A 66 y/o Man complains of chest pain for three hours. The 12 lead ECK shows?

A

Inferior Myocardial Infarction

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2
Q

Which coronary artery supplies the majority of the circulation to the inferior portion og the heart?

A

Right Coronary Artery

Supplies the majority of the inferior portion of the heart and some of the posterior portion of the heart.

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3
Q

V1-V6 chest leads are categorized as?

A

Precordial or Unipolar leads

Views the heart from a horizontal plane

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4
Q

What can be used to determine the ST elevation, ST depression, or QRS duration on the ECG?

A

The J-point

J-point is known as the area where the S wave changes direction.

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5
Q

What type of maocardial infarction does the following 12-lead ECG show?

A

Posterior MI

R waves increase, ST depression (reciprocal changes) present in V1-V4.

Development of tall R waves in the Right precordium should be interpreted as evidence of posterior MI.

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6
Q

ST elevation on the ECG tracing can indicate?

A

Injury

The three ST stages are:

ST elevation = injury (acute MI)

ST depression = Ischemia

Q-waves present that measure 25% of the R wave = Infarction

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7
Q

Hyperkalemia > 7.0 can exhibit which of the following changes on the ECG tracing?

A

Tented or peaked T waves greater than 5mm can indicate the presence of Hyperkalemia.

Flattened T waves/U waves present, which occur just after T waves are usually smaller in amplitude than the T wave = Hypokalemia.

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8
Q

A 50 y/o man presents with chest pain for three days. What does the following 12-lead ECG show?

A

Anterior MI

ST elevation present in V3, V4, laed I and aVL

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9
Q

What is a characteristic of the 12-lead ECG for a patient with a history of WPW?

A

The Delta Wave

The delta wave is due to early conduction through the accessory pathway.

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10
Q

Interpret the following ECG tracing.

A

Complete AV Block (third degree)

Charteristics include no constant PRI

P waves are NOT related to QRS complexes

P waves regular to each other

QRS complexes are regular to each other

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11
Q

ST depression can indicate all of the following except?

A

Old Injury

Acute injury is indicated by the presence of ST elevation.

Ischemia, old infarction and digitalis toxicity can present with ST depression.

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12
Q

Q waves present with ST elevation can indicate?

A

Acute Injury

Q wave with ST depression or T wave inversion = Indeterminate

Q wave without ST changes = Old Injury/Infarction

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13
Q

Interpret the following ECG tracing.

A

100% Ventricular Paced Rythm

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14
Q

Your patient presents with epigastric pain, nausea, and vomiting for one hour. He describes his chest pain as “heavy in nature”. What does the following 12-lead ECG show?

A

Inferior Wall MI

ST elevation in leads II, III, aVF

(reciprocal changes in I, aVL)

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15
Q

Interpret the following ECG tracing

A

Polymorphic V-tach

(formerly known as Torsades de pointes)

Polymorphic = QRS will NOT be symetrical.

Monomorphic = QRS waves WILL be symetrical.

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16
Q

Your patient is exhibiting ST elevation in leads II, III, aVF. ST depression is noted in V1-V3. Which of the following may prove hazardous?

A

Nitroglycerin

Pt’s 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 pt has been managed with IV fluids prior to administration.

(Diagnosis of Right ventricular MI can be done by obtaining a Right-sided 12-lead ECG)

The presence of ST elevation in V4R is a highly sensitive marker for Right ventricular invlovement.

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17
Q

A 55 y/o woman complains of SOB for two days. Identify what the following ECG rythm reveals.

A

Anteroseptal MI

Presents with ST elevation in precordial leads V1 - V4

(reciprocal changes ST depression in II, III, aVF)

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18
Q

In which sequence does blood flow through the heart valves?

A

Tricuspid, Pulmonic, Mitral, Aortic

(Toilet Paper My Ass)

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19
Q

What condition may the following ECG indicate?

A

Hyperkalemia

Peaked or tented T waves indicate Hyperkalemia with usually a serum lab value of > 7.0

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20
Q

Interpret the following ECG tracing

A

Atrial Fibrilation with ST elevation

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21
Q

The ECG may show peaked P waves, flattened/slurred T waves, and appearnce of U waves, which may indicate?

A

Hypokalemia

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22
Q

Interpret the following ECG

A

Atrial Fibrilation with BBB

R-R waves are regularly irregular with no discernible P waves present

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23
Q

Inferior wall MI is caused by occlusion of which coronary artery?

24
Q

The following ECG reveals?

Study These Flashcards
A

Anteroseptal-lateral wall MI

ST elevation is present in leads I, aVL, V5, V6 (lateral wall), V1, V2 (septal), V3, V4 (anterior wall)

Reciprocal changes (ST depression) present in inferior leads II, III, aVF.

25
Intrepret the following ECG tracing
Second-degree AVB, Mobitz II **PR interval is constant** and there are **more P waves present than QRS** complexes. **R-R interval is regular** because there is a 2:1 conduction that remains constant. **"P waves march out"**
26
On 12-lead ECG, posterior wall MI's manifest as?
ST depression in V1-V4 with abnormally tall R waves. Progression of abnormally tall R waves and ST depression in precordial leads in chest leads V1 V4. Changing leads to posterior will show ST elevation
27
Interpret the following ECG tracing
Pacer Spikes with Failure to Capture
28
Interpret the following ECG tracing
Lateral Wall MI ST elevation in Lateral leads I and aVL Reciprocal changes in leads II, III, aVF
29
A patient with a history of tricyclic antidepresent overdose can exhibit which of the following on the ECG tracing?
Prolonged QT interval Widened QRS \> 0.12 sec.
30
Normal K+ lab value?
3.5 - 4.5
31
Interpret the following ECG tracing
Idioventricular Rythm Ventricular rate of 20-40, wide QRS \> 0.12 and no P waves present. Accelerated idoventricular rythm is defined as a ventricular rate of 40-60 beats per minute, wide QRS \> 0.12 sec and no P waves present.
32
Interpret the following ECG tracing
Second-degree AVB Mobitz Type I (Wenckebach)
33
Your IABP begins to purge during ascent. The triggering mechanism for this function was initiated as a result of which gas law?
Boyle's Law The expansion (**ascent**) or contraction (**descent**) of gas. Other equipment affected ETT cuff, which may increase in size with ascent.
34
The balloon has dislodged when treating your patient. Which is the most common site that will be affected?
Left Radial Artery
35
During transport you note rust-colored "flakes" in the IABP tubing. This indicates?
Balloon Rupture
36
Interpret the following IABP strip
Early Inflation If the inflation point is 2mm or more from the dicrotic notch, it indicates early inflation. **Precise timing** of the balloon inflation/deflation **is essential** to achieve hemodynamic effects that increase coronary blood flow decreasing the workload of the heart. The arterial pressure waveform is **ALWAYS** used to set and assess the timeing. **_Timing should always be assessed in a 2:1 assist ratio so that a comparison of the assisted and unassisted landmarks can be made._**
37
The primary trigger used for most IABP operations is the ?
CVP Catheter ## Footnote **Most common is the ECG using the R wave.**
38
When timing the IABP, inflation should initiate in synchronization with?
Dicrotic Notch Indicated on the A-line Pressure Wave It is important that the **inflation** of the IAB **occurs at the onset of ventricular diastole**, noted on the dicrotic notch on the arterial waveform.
39
Identify the following IABP timing strip
Late Deflation **_Most Potentially Harmful Timing Error!!!_** Timing errors cause decrease in arterial pressures, decrease in cardiac output, decrease in ejection fraction, increase in heart rate, increase in pulmonary artery diastolic pressures, and increase in capillary wedge pressures.
40
During transport you experience a complete IABP failure. You should?
Cycle the balloon manually every thirty minutes regardless of timing when managing IABP failure
41
**Cardiac Responses**
Decreased contractility = HR **increases** Hypoxia = pulmonary arteries **constrict** (pulmonary hypertension) Decrease in systemic perfusion = vessels **constrict** (except in neurogenic (distrubutive) spinal, septic and anaphylactic shock) **Systemic decrease in vasoconctriction will decrease CO**
42
**Cardiac Output (CO)**
Amount of blood pumped by the heart per minute = HR x Stroke Volume **4-8 L/min**
43
**Pulmonary Vascular Resistance (PVR)**
Measures Afterload of **Right Heart** **Increased PVR** = acidosis, hypercapnia, hypoxia, atelectasis, ARDS **Decreased PVR** = alkalosis, hypocapnia, vasodilating drugs **50-250 dynes**
44
**Systemic Vascular Resistance (SVR)**
Measures afterload of the **Left** Heart **Increased**: hypothermia, hypovolemic shcok, decreased CO **Decreased**: anaphylaxis, neurogenic (distributive) shock, spinal shock, septic shock, vasodilating drugs **800-1200 dynes**
45
**Right Coronary Artery (RCA)**
Supplies the **Right ventricle** and in most people the SA node (60%) Inferior MI Bradycardia due to SA node involvement
46
**Left Coronary Artery (LCA)**
Complete block of artery caled "widow maker" Occludes both the LAD and LCX (entire Left heart) "Left Main"
47
**Left Anterior Descending (LAD)**
Supplies anterior Left ventricle and anterior septum Anterior MI Septal MI Anteroseptal MI
48
**Left Circumflex (LCX)**
Supplies lateral Left ventricle/posterior Left ventricle in 45% of people Lateral MI Posterior MI
49
**Inferior MI**
**Right Coronary Artery** ST segment changes in II, III, aVF Obtain a Right-sided EKG (V4R) Fluid challenge Use caution with NTG/Morphine (Fentanyl probably better suited) Avoid beta blockers
50
**Anterior MI**
Left Anterior Descending Artery Segment changes in v2, v3, v4 Carries worst prognosis due to large area "Fona" Fentanyl, oxygen, ntg, asa "Mona" Morphine, oxygen, ntg, asa
51
**Posterior MI**
Posterior Descending Artery Posterior Mi is suggested by depression in V1 - V3 Horizontal ST depression Tall broad R waves (\>30ms) Upright T waves Dominant R wave (R/S ratio \> 1 in V2) Reciprocal changes not always present
52
**Effects of the IABP**
**Increase** coronary perfusion **Decrease** workload on heart Timed EKG waveform Systole = deflated Diastole = inflated
53
**Normal IABP Timing**
Decreases workload Increases coronary perfusion
54
**Early IABP Inflation**
Inflation before aortic valve closure Forces blood back into Left Ventricle Aortic regurgitation Decreased CO Increased SVR U shape HARMFUL
55
**Late IABP Inflation**
Inflation after aortic valve closure Suboptimal augmentation **Decreased** coronary perfusion **"W" shape**
56
**Early IABP Deflation**
Decreased negative pressure **Increased afterload** Deflation of balloon before systole **"Cliff" Shape** (sharp decline like falling off cliff)
57
**Late IABP Deflation**
**WORST TIMING ERROR** Increased workload Increased afterload Inflation of balloon during systole "Widened Appearance" shape **HARMFUL**

CC-P Module I ECG and IABP (1 decks)

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