Cardiology final

V1 & V2 ventricular surface

Septal

V3 & V4 Ventricular surface

Anterior

Lead 1, aVL, V5 & V6 ventricular surface

Lateral

Lead 2, 3 & aVF ventricular surface

Inferior

Ischemia

Cells function and will recover with restoration of perfusion

Injury

cells are non functional or impaired. Death is imminent but they can recover if perfusion is restored in time

Infarct

Cells that are dead

Criteria for significant STE

• J point is more than 1mm above baseline

• Q waves more than 25% the height of R wave

• QS complexes in 2 or more contiguous leads

LAD artery supplies

• anterior 2/3 of septum

• Anterior wall LV

• Bundle branches

RCA supplies

• inferior wall/ AV node for 90% of pts

• SA node in 50%

LCx artery supplies

• lateral wall

• Inferior wall/ AV node in 10% of people

Complications with a Septal infarct

• BBB

• 2nd degree

• 3rd degree

Possible complications of an anterior infarct

• LVF

• Pulmonary edema

• Cardiogenic shock

Possible complications of a lateral infarct

• moderate LVF

• CHF

Possible complications of an inferior infarct

• AV blocks with normal QRS

• RHF

• Atrial arrhythmias

When LAD artery is occluded

Infarct in septum and anterior wall

When LCx artery is occluded

Infarct in the lateral wall

In 10% of people, the LCx artery can cause

An inferolateral MI

When the RCA is occluded

The infarct is in the right ventricle and inferior wall

When the L main artery is occluded

The infarct is anterior and lateral

5 most common STEMI mimickers

• LVH

• LBBB

• Paced/ ventricular rhythm

• Early repolarization

• Pericarditis

Placement for anterior/ later defib pads

White pad below right clavicle to the right of the sternum red pad centered over V6

Placement for anterior posterior defib pads

White pad below left scapula to the left of vertebral column red pad over V4

Drugs to consider for sedation of a contra patient about to be synchronized or cardioverted

Diazepam, Midazolam, lorazepam

Drugs to consider for analgesia of a patient about to be synchronized or paced

Morphine fentanyl ketamine

Rate for ventricular tachycardia

100-250

Great for junctional tachycardia

100-250

AVIR rate

40-100

Accelerated junctional rate

60-100

Afib atrial rate

350-750+

A flutter atrial rate

220-360, most commonly 300

SVT rate

150-250

Output failure from a pacer

No pacer spike

Failure to capture from a pacemaker

No consistent depolarization following pacer spike

Undersensing from a pacemaker

Pacer spikes follow native beats too closely

Oversensing from a pacemaker

No pacer spikes occur despite native rate

Starting energy for a fib

120 J

3rd degree AV block

More ps than QRS, Ps plot, RR plots, PRI varies

Second degree heart block

Extra p waves, p waves plot, PRIs lengthen, RR shorten

MAT

3 different p waves, OVER 100

AIVR rate

40-100

IVR rate

Less than 40

1st degree Av block

LENGTHENED PRI

WAP

3+ pacers, rate less than 100

The expected changes to an EKG follow a particular expected order as blood flow continues

• peaked T waves

• STE

• Pathologic Q waves

order of the ion movements from phase 0- phase 4

1) Na+ into the cell

2) K+ out of the cell slowly

3) Ca++ in to the cell and K+ out of the cell

4) K+ out of the cell rapidly

5) No net movement 

Phase 1 represents

the period where the myocardium will not respond to another stimulus

Phase 2 represents

the period that the myocardium can respond to a larger than normal stimulus

The likeliest location to find a non-conducted PAC

Phase 2

Rythym that’s irregular with no evidence of p waves is always

A fib