12-Lead ECG's
The Septal leads are part of the 6 Precordial leads. What are these 2 leads called and where are they placed on the chest?
What is V1 and V2.
V1 right sternal border, 4th ICS.
V2 left sternal border, 4th ICS.
You do a 12-lead ECG of a 45 year old female presenting with epigastric discomfort, lethargy and diaphoresis. The ECG shows ST elevation in precordial leads V1 through V6. What type of MI is she having? Which coronary artery is affected? What are a few complications?
Anterolateral MI.
Left anterior Descending, circumflex
Cardiogenic shock
Vfib, Vtach pulseless
A 48 year old female presents with mild sternal discomfort that only occurs on exertion. The 12-lead shows T-wave inversions in V1-V4. You treat her with Nitro, asa, and oxygen. The repeat ECG is normal and the patient does not have any symptoms. What type of cardiac condition does she have?
What is stable angina?
Your patient is having an inferior MI. VSS You are getting ready to transport when you notice she is in 3rd degree AV block. What do I do?
Notify MD. Get help apply pads to patient.
Assess patient's vs, ABC's, Neuro status.
if unstable transcutaneously pace.
You do a 12-lead ECG and notice old Q waves throughout leads I, AVL, V5, V6. What am I?
What is old lateral infarction.
Why do we do 12-lead ECG's?
Multiple Reasons: observe electrical conduction through the heart, look for ischemia,injury, infarction, electrolyte imbalance, pericarditis,and because we get them on everyone with heart
You do a 12-lead ECG of a 60 year old female presenting with epigastric discomfort, lethargy and diaphoresis. The ECG shows ST elevation in I, AVL, V5, V6
What type of MI is she having? What coronary artery is affected? What are some complications?
Lateral MI Circumflex artery
Cardiogenic shock, LVHF, pulseless vtach, vfib
A 58 year old male presents with sternal discomfort that occurs at rest. The 12-lead show St depression and T wave inversions in I, AVL, V5, V6. He is treated with nitro, asa, morphine, and oxygen. His symptoms are alleviated. The repeat ECG show the same depression and inversions. What type of cardiac condition does he have?
What is a NSTEMI?
Your patient is having an anterolateral MI. The patient begins to have runs of 12 beat VT followed by multifocal PVC's. What should you do?
Notify the MD. Get help.
Make sure pads are on correctly prepare to defibrillate if necessary.
Assess ABC's, neuro status
Prepare and amiodarone infusion
You do a 12-lead ECG and notice flipped T-waves V1 to V4. What am I?
What is anterior Ischemia
The Lateral leads are part of the 6 precordial leads. What are these 2 leads called and where are they placed on the chest?
V5: left anterior axillary line 5th ICS
V6: left midaxillary line 5th ICS
You do a 12-lead ECG of a 60 year old female presenting with epigastric discomfort, lethargy and diaphoresis. The ECG shows ST elevation in V1, V2.
What type of MI is she having?
Which coronary artery is affected? What are some of the complications.
Septal MI
LAD
Cardiogenic shock, LVHF, Vtach pulseless, Vfib
You do a 12-lead on a 85 year old renal failure patient who missed his last 2 dialysis treatments. You notice tall T waves in all the leads. What are you concerned for? What are some of the treatments?
Hyperkalemia
D50,insulin, calcium
You have started your patient on nitro sublingual for chest pain 8/10. After the first dose the patient becomes hypotensive and diaphoretic. What should you do?
Notify the MD.
Assess ABC's make sure IV access is working.
Repeat ECG anticipate ivf order.
Do not give more nitro.
You do a 12-lead ECG and notice St segme t elevation in leads II,III,AVF. What am I?
What is inferior injury
You do a 12-lead ECG and notice Q waves in I, AVL, V5, V6
What side of the left ventricle am I? What does the Q wave mean ischemia, injury, infarction?
What is Lateral side of the left ventricle. Old lateral MI
You do a 12-lead ECG of a 65 year old male presenting with jaw pain radiation to the left shoulder and arm. On assessment you note an elevated JVD, normal lung sounds, and hypotension.The ECG shows ST elevation in II, III, AVF. What type of MI is he having? Which coronary artery is affected? What are some of the complications.
What other ECG may you consider?
Inferior MI right ventricle
Right coronary artery
complications hypotension, atrial arrythmias, preload dependent.
Right sided ECG look at RV3, RV4,RV5,RV6
A 72 year old female recently diagnosed with CHF and was started on lasix 2 weeks ago. She complains of dizziness and skipped beats. The 12 lead shows frequent PVC's. What do you think she may have?
Hypokalemia secondary to the loop diuretic.
Your patient is having a anterolateral MI. Vitals are stable when leaving the ED. On your way to the elevator you notice your patient becomes unresponsive and the monitor shows Vfib. What do you do?
Check for unresponsiveness, check pads, follow ACLS protocol and shock the patient. Bag the patient and begin CPR.
You do a 12-lead ECG and notice ST segment depression throughout V1 to V4. What am I
What is anterior ischemia
The five step procedure for ECG analysis.
What is rate, rhythm, P waves, PR intervals, and QRS complex?
You do a 12-lead ECG of a 45 year old male presenting with severe sternal chest pressure for 3 hours. The ECG shows ST depression and tall T waves in V1, V2.
What type of MI is he having? What type of ECG might you want to do?
Which coronary artery is affected? What are some of the complications.
Posterior MI
Posterior ECG
Coronary artery circumflex or RCA
Complications Cardiogenic shock LVHF, Vtach, Vfib
A 35 year old baseball player recently traveled to South America to play a tournament. He felt like he had the flu-like symptoms. He presents with lethargy and fatigue. Complains of sternal burning. The 12-lead shows ST elevation in all the leads. What may he have? How is it treated?
Pericarditis
Anti-inflammatories colchicine
complications: tamponade, myocarditis
Your patient has been diagnosed with hyperkalemia. The orders call for insulin, D50, and calcium.
What is given first and why?
What is calcium. Helps the heart to beat normally by binding to the troponin complex to make the heart cell squeeze together.
You do a 12-lead ECG and notice ST elevation in leads II,III,AVF. and ST elevation in leads V4R, V8, V9.
What am I?
What is acute inferior/posterior STEMI
Injury