Ischemia, Injury or Infarction
The SEPTAL leads are part of the 6 PRECORDIAL leads. What are these 2 leads called and where are they placed on the precordium?
What is V1, V2 V1: 4th ICS, right sternal border V2: 4th ICS, left sternal border
You do a 12-lead ECG of a 45 year old female presenting with epigastric discomfort, lethargy and diaphoresis for several hours. The 12 Lead ECG shows ST elevation in precordial leads V1 through to V6. What is happening?
What is Anterolateral STEMI?
Coronary Artery: Left Anterior Descending and Circumflex or Left Main (LCA)
Complications: Cardiogenic Shock, Lethal arrhythmias
A 48 year old female presents with mild sternal discomfort that only occurs on exertion. A 12-lead ECG shows T wave inversions in V1 through to V4. She is treated with Nitrates, ASA and Prasugrel and started on SQ Fragmin. The repeat ECG appears normal. What type of cardiac condition does she have?
What is ACS with LAD ischemia?
My patient is having an inferior MI. She has adequate VS. You are waiting for the Cath lab team/medical transport. Suddenly the monitor shows a wide QRS complex rhythm. The MAP is 40 mmHg.
What is idioventricular rhythm?
Prepare to start pacing and pressors for BP support
There are 3 BIPOLAR FRONTAL leads. These are commonly referred to as the limb leads. Which lead has a negative electrode on the right arm and positive electrode on left leg?
What is LEAD II
You do a 12-lead ECG of a 45 year old female presenting with epigastric discomfort, lethargy and diaphoresis for several hours. The ECG shows ST elevation in I, AVL, V5, V6 What type of MI is she having? Which coronary artery is affected? What complications can occur?
Type: Lateral STEMI Coronary Artery: Circumflex Complications: Cardiogenic Shock, LVHF, Vtach, Vfibb
A 58-year-old male presents with sternal discomfort that occurs at rest. A 12-lead ECG shows ST depressions and T wave inversions leads I, AVL, V5, V6. You treat him with ASA, IV Heparin and Prasugrel along with oxygen for R/A sat of 90%. A repeat ECG shows the same ST depressions and T wave inversions leads I, AVL, V5, V6 and positive Troponin. What type of cardiac condition does he have?
What is an NSTEMI if the patient has positive troponin I or unstable angina.
My patient is having an inferior MI. She is had adequate VS. You are waiting for the cath lab team/medical transport. Suddenly the monitor shows sinus bradycardia at 30 beats per minute. What do I do?
What is symptomatic bradycardia?
Notify MD, call for help assess ABC, LOC and MAP.
Stable - atropine,
Unstable - external pacing + pressors for BP support
Why do we do 12-lead ECG's
What is for many reasons: observe electrical conduction through different walls of the heart, look for ischemia, injury, infarction, electrolyte imbalance, pericarditis, size and shape of heart, axis etc.
You do a 12-lead ECG of a 65 year old female presenting with epigastric discomfort, lethargy and diaphoresis for several hours. The ECG shows ST elevation in precordial leads V1, V2, V3 and V4 What type of MI is she having? Which coronary artery is affected? What complications can occur?
Type: Anterior STEMI Coronary Artery: LAD Complications: Cardiogenic Shock, LVHF, Vtach, Vfib
My patient is having a massive anterolateral MI. The patiet has a run of 12 beats of VT followed by multifocal PVCs. I am waiting for the Cath lab team/transport team to arrive. What are my nursing actions?
What is : notify MD ASAP assess patient ABC, LOC, ensure PADs are on, connected to DEFIB machine prepare for Amiodarone infusion
You do a 12-lead ECG and notice ST segment depression throughout the V1 to V4 precordial leads. What am I? (which aspect of the left ventricle is affected and ischemia/injury/infarction)
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 precordium?
What is V5, V6 V5: 5th ICS, left anterior axillary line V6: 5th ICS, left midaxillary line
You do a 12-lead ECG of a 65 year old male presenting with jaw pain radiating to the left shoulder and arm. On assessment you note an elevated JVD, normal lung sounds, and he is hypotensive. The 12-lead ECG shows ST elevation in leads II, III, AVF. What type of MI is he having? What other ECG may you consider? Why? Which coronary artery is affected? What complications can occur?
Type: Right-Ventricular (+Inferior) STEMI ECG: 15-lead ECG (look at V3R, V4R, V5R, V6R: right ventricular leads) Coronary Artery: RCA Complications: hypotension, atrial arrythmias, heart blocks, preload dependent
A 72-year-old female was recently diagnosed with HF and started on furosemide by her family doctor 2 weeks prior. She present to your emergency department with orthostatic hypotension and dizziness, and complaining of skipped beats. You do a 12-lead ECG and notice that she has U waves present with several PVC's. What do you think she may have?
What is HYPOKALEMIA secondary to loop diuretic use.
It is your first week on orientation after the Humber program has finished. You are waiting for the Cath lab team/medical transport for your STEMI patient. The patient is c/o 8/10 chest pain. The physician orders a stat nitro dose. After treating the patient with nitro, the patient becomes very hypotensive. What will I do?
What is Vasodilation?
Notify MD and assess, ABCS
Anticipate fluid bolus (as per medical orders)
no more NITRO!
Get a 15 Lead ECG.
You do a 12-lead ECG and notice ST elevation in leads II, III, AVF. Your follow up 15-lead ECG shows ST elevation in leads V4R, V8 and V9. What am I? (which aspect of the heart/left ventricle is affected and ischemia/injury/infarction)
What is ACUTE INFERIOR/POSTERIOR STEMI (INJURY)
There are 3 UNIPOLAR FRONTAL LEADS. Commonly referred to as the augmented leads. The center of the chest is always the negative reference point. Which lead has an electrode on the right shoulder? What is the inflection of the QRS (positive, negative)
What is AVR
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 leads V1 and V2 only. The AVR lead also looks abnormal. What type of MI is he having? Which coronary artery is affected? What type of ECG do you want to do? Why? What complications can occur?
Type: Posterior STEMI ECG: 15-lead ECG (look at V4R, V8, V9 posterior leads). Coronary Artery: Circumflex or RCA Complications: Cardiogenic Shock, HF, Vtach, Vfib
A 35-year-old professional baseball player admits to catching a "flu-like" virus while he was travelling. He continued to play in the tournament despite feeling unwell. He presents to your emergency with lethargy and fatigue. He complains of sternal burning. A 12-lead ECG shows ST elevations in all leads. What may he have?
What is PERICARDITIS
Treatment: antiinflammatories
My patient is having a massive anterolateral MI. They are vitally stable. You are waiting for the cath lab team/transport team to arrive in the ED or ICU. The patient becomes unresponsive and the monitor shows vfib. What will I do?
What is a VFib Arrest?
Call for help, start compressions, place universal pads and attach DEFIB machine. Defibrillate as soon as possible.