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ST segment and hypertrophy Flashcards

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1
Q

what does the ST segment signify

A

period between ventricular depolarization and repolarization

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2
Q

where is the J point

A

where the QRS and ST segment meet

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3
Q

in what situations is the J point harder to identify

A

LVH with strain
early repel
pericarditis

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4
Q

what is considered a normal ST segment

A

at baseline; smooth transition to t wave

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5
Q

what is considered ST segment changes

A

> 2mm from baseline in 2 or more leads; can be above or below baseline=abnormal!

flattened ST segment with not much of a wave is also possible pathology

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6
Q

what does ST segment depression indicate

A

ischemia; NSTEMI

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7
Q

what does ST segment elevation indicate

A

infact; STEMI

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8
Q

name some benign ST segment changes and whether it would be elevated or depressed

A

pericarditis-elevation
early repol-elevation
LVH with strain- elevated or depressed
BBB-elevated/depressed

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9
Q

ST segment elevation with upward concavity (esp with notching of the j point) is….

A

benign

:) happy face

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10
Q

ST segment elevation with downward concavity/ “coving”…

A

BAD=infarct

:( sad face

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11
Q

how should the T wave normally look

A

assymetrical

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12
Q

if the t wave looked symmetrical and tall what could this indicate

A

ischemia/infarct

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13
Q

if the t wave was tall, narrow, peaked, and symmetrical what could this indicate

A

hyperkalemia

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14
Q

IF THE t wave was broad and wide what could this indicate (plus a wide QRS)

A

intracranial hemorrhage

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15
Q

what height is considered abnormal for a t wave

A

> 2/3 height of the R wave

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16
Q

the T wave is normally positive in which leads

A

I, II, V3-V6

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17
Q

which lead normally has a negative T wave

A

AvR

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18
Q

if a t wave is flat/inverted in 1 lead this is

A

benign

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19
Q

if a t wave is flat/inverted in multiple leads this is

A

pathologic for ischemia

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20
Q

if you have a biphasic T wave and the first part is + this is

A

benign

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21
Q

if you have a biphasic T wave and the first part is negative this is

A

pathologic

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22
Q

what are the clinical features of pericarditis

A

ST segment elevation
notching of the QRS
PR segment depression

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23
Q

what does early repolarization look like

A

benign ST seg elevation
NO PR segment depression
notching of the QRS
found in young/athletes

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24
Q

for right atrial enlargement what lead should you look at first

A

lead II

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25
what does lead II show in RAE
> 2.5 mm in height, peaked shaped think rising right!!
26
if the p wave in lead V1 is biphasic how can you tell if its RAE
the positive half is taller and wider
27
if the p wave in lead II is > 0.12 seconds long what is this indicative of
Left atrial enlargement
28
if you see a M shaped/ camel humped p wave in lead II what is this indicative of
LAE
29
how will the p wave look in V1 if there is LAE
biphasic wave with the - wave being wide (at least 1 small box) and deep
30
how does biatrial enlargement appear
MIXED criteria of both LAE and RAE
31
what are the 2 causes of LVH
increased pressure- HTN, AS | increased volume- AI, MR
32
how can LVH with strain confuse you for ischemia
ST segment and t wave inversion is normal part of strain - not having an MI
33
what is the criteria for diagnosis of LVH
the deepest S wave in leads V1/V2 + tallest R wave in V5/V6 = > 35 mm
34
when can the criteria for LVH not be used
in the presence of LBBB, WPW, ventricular rhythms, e- disturbances, drug effects BASICALLYYYY anything that effs with the QRS complex shape
35
if the R wave in AvL is > 11mm what is this indicative of
LVH
36
monomorphic S waves in I and V6 are indicative of what
LBBB
37
ST depression and inverted t waves
ischemia
38
ST elevation with or without t waves
infarct
39
what is the normal limit of ST segment elevation before it is pathology
1mm in limb leads
40
ST segment that con caves up is ….
strain | infarct
41
very broad t waves is significant of
CNS events stroke intracranial hemorrhage
42
if the t wave is >2/3 the height of the R wave this is
pathology
43
if a t wave is flat this is
pathology
44
a tall peaked t wave in the precordial leads
hyperkalemia
45
hyperkalemia can lead to what
IVCD: Right and left BBB
46
what is the criteria for RVH with strain
``` RAE RAD RVH ST depression concave down inverted t wave ``` S1Q3T3
47
S1Q3T3 is the pneumonic for what
PE
48
T/F: ST elevation/depression if flat, is usually ischemia
TRRUUUE DAT
49
what is the LVH with strain pattern
ST elevation concave upward in leads V1-V3 and ST depression concave downward in V4-V6
50
what is the criteria for RVH
in lead V1 the R:S ratio is >1:1
51
if you see concordance with a BBB this is significant for
ischemia concerning for infarct
52
flat t waves signify
ischemia | infarct
53
inverted t waves signify
ischemia infarct strain
54
new LBBB with cardiac sx is considered
an MI equivalent
55
describe the carousel pony of a posterior wall MI
in V1/V2 you see ST depression, a big fat tall R wave, and an UPRIGHT t wave
56
when you see an inferior wall MI what else should you check for
right wall MI | posterior wall MI
57
if you saw a carousel pony how could you distinguish it from RVH with strain
RVH with strain has an INVERTED t wave whereas pony has an upright t wave
58
if there is an MI in the lateral wall where would the reciprocal changes be seen
Inferior leads
59
which coronary artery supplies the anterior, lateral, and septal part of the heart
LAD
60
what is the first sign of an MI progression
t wave inverts then the ST segment depresses, ST elevates, q waves
61
downward sloping ST depression in AvL is indicative of what
inferior wall MI
62
criteria for an RVI
ST segment elevation in III > than that in II | IWMI
63
which artery supplies the inferior wall and RV
RCA
64
true or false: anteroseptal MI's have reciprocal changes
false; we cannot see the posterior wall
65
when you have a LWMI where are the reciprocal changes seen
inferior leads shows ST depression
66
anteroseptal MI with lateral extension is caused by the blockage of which coronary A
LAD
67
AMIs can cause
AV blocks BBB arhythmias
68
if you have an Apical MI what area is involved
I, II, III, AVF, AVL, V2-V6 | inferior, lateral, anterior
69
an apical MI is caused by the blockage of what artery
RCA
70
when you see ST elevation in I and II you should think its….
pericarditis APICAL MI!! aortic dissection with global infarct
71
when you see an inferior wall MI you should...
order right and posterior leads!! think PWMI and RVMI
72
which leads should you look at to check for a posterior wall MI
V1 and V2

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