EKG sites + exercise tests

for FUCKS SAKE

Right arm lead

2mm medial to the deltoid and 2mm inferior to the clavicle

Left arm lead

2mm medial to the deltoid and 2mm inferior to the clavicle

right leg lead

½ between lower costal margin and iliac crest

left leg lead

½ way between lower costal margin and iliac crest

V1

4th intercostal space, right sternal edge

V2

4th intercostal space, left sternal edge

V3

right between V2 and V4

V4

5th intercostal space, mid-clavicular line

V5

5th intercostal space, anterior axillary line

V6

5th intercostal space, mid axillary line

plain gxt

rule out ischemic heart disease, determine aerobic capacity, vo2 max, hr, bp, egg, pre, respiration rate the whole thingy

Nuclear exercise test

Determine presence or absence of coronary heart disease, asses extent of damage of MI, clear ppl for surgery, evaluate them for chest pain

radioactive isotope injected with an IV, pre exercise image in taken, exercise is done, an after image is taken// compare baseline to ipe to determine if there is a reperfusion defect

reperfusion defect

seen in nuclear exercise tests, is there a bite missing from the donut?

a defect at rest is abnormal and is called a fixed defect and is consistent with an old MI

repefusion defect at exercise is indicative of ACUTE ischemia or an active MI

ischemia can be superimposed on a fixed defect

pharmacological perfusion study

if for whatever reason the subject can’t exercise, CNS disorder, pain, not cognitively able than a pharmacological agent (adenosine) maybe given to simulate exercise.

isotope injected > pre imaging taken > adenosine injected > post imaging taken

can be done in conjunction with the GXT

looks at hemodynamics

flushing SOB chest pain, dizziness nausea

wall motion abnormalities

occur as a result of an MI because dead cardiac tissue doesn’t contract as well

echocardiogram, use ultrasound to look at heart

ischemia can can global dyskenesia (abnormal of decreased contractility of cardiac muscle)

ischemia

contractility may worsen with exercise

echocardigram

ultrasound imaging of the heart, can be performing at rest or during exercise test

tells us about contractility, chamber size, valves, ejection fraction

Ejection fraction

how much blood the left ventricle pumps out

the lower the EF the worse the prognosis

EF <40% is bad

coronary angioplasty

stent is placed in an artery to keep in open

holter monitor

24hr ekg monitor to record events

indications// arrhythmia detection, chest pain, ekg given to enhance pts diagnosis

angiogram

invasive procedure

cathether placed up arteries to see where blood blow is occluded

GOLD STANDARD again which all tests are compared against

coronary artery bypass surgery

traumatic as fuck, take a vein from somewhere and put in somewhere else

event monitor

on for 30 days, not on the whole day, like a diary