I love my heart

Ischemia, Injury or Infarction

100

You do a 12-lead ECG and notice old Q waves throughout leads I, AVL, V5, V6. What am I? (which aspect of the left ventricle is affected and ischemia/injury/infarction)

What is LATERAL INFARCTION (old LATERAL MI)

200

You do a 12-lead ECG and notice flipped T waves 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

300

You do a 12-lead ECG and notice ST segment elevation in leads II, III, AVF. 15-lead ECG shows no posterior changes, Right-sided ECG shows no changes in V4R. What am I? (which aspect of the left ventricle is affected and ischemia/injury/infarction)

What is ACUTE INFERIOR STEMI (INJURY)

400

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

500

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)

12-Lead ECG's

100

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

200

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

300

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.

400

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

500

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

I think I'm Infarcting!

100

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 precordial leads V1 through to V6 What type of MI is she having? Which coronary artery is affected? What complications can occur?

Type: Anterolateral STEMI Coronary Artery: Left Anterior Descending, Circumflex (LCA) Complications: Cardiogenic Shock, LVHF, Vtach, Vfibb

200

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

300

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 What type of MI is she having? Which coronary artery is affected? What complications can occur?

Type: Septal STEMI Coronary Artery: LAD Complications: Cardiogenic Shock, LVHF, Vtach, Vfibb

400

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

500

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. 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, LVHF, Vtach, Vfibb

What's my heart condition?

100

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. You treat her with Nitro, ASA and oxygen. A repeat ECG appears normal. What type of cardiac condition does she have?

What is STABLE ANGINA

200

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 Nitro, ASA, morphine and oxygen. His symptoms are alleviated. A repeat ECG shows the same ST depressions and T wave inversions leads I, AVL, V5, V6. What type of cardiac condition does he have?

What is an NSTEMI or unstable angina

300

You do a 12-lead ECG on a 85 year old renal failure patient who forgot to go to the last 2 dialysis treatments because he was watching world cup soccer. You notice tall T waves in all leads of 12-lead ECG. What are you concerned for? What are some treatments for hyperkalemia?

What is HYPERKALEMIA Treatments: D50W, insulin, calcium gluconate, ventolin, kayexelate, loop diuretics

400

A 72 year old female was recently diagnosed with CHF and started on furosemide by her family doctor 2 weeks prior. She present to your emergency department with orthostatic 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

500

A 35 year old baseball player recently traveled to South America to play in a tournament. He admits to catching a "flu-like" virus while he was there but says he continued to play in the tournament despite feeling unwell. He present 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? How is this treated?

What is PERICARDITIS Treatment: antiinflammatories

Eek! What do I do?

100

My patient is having an inferior MI. She is vitally stable. You are waiting for the cath lab team/medical transport. Suddenly the monitor shows a 3rd degree AV block. What do I do?

What is notify MD, call for help assess ABC, LOC check vitals attach pads stable - monitor unstable - external pacing + sedation

200

My patient is having an inferior MI. She is vitally stable. You are waiting for the cath lab team/medical transport. Suddenly the monitor shows a sinus bradycardia at 30 beats per minute. What do I do?

What is notify MD, call for help assess ABC, LOC check vitals attach pads stable - atropine, if not working then pace unstable - external pacing + sedation, dopamine

300

My patient is having a massive anterolateral MI. They are vitally stable. I am waiting for the cath lab team/transport team to arrive. I start to notice they are having 4-8 beat runs of VT in between their NSR. What will I do?

What is : notify MD ASAP assess patient ABC, pulses, vitals ensure PADs are on, connected to DEFIB machine prepare for amiodarone infusion

400

My patient is having an inferior STEMI. You are waiting for the cath lab team/medical transport. They are vitally stable. The physician orders nitro. After treating my patient with nitro, my patient become very hypotensive. What will I do?

What is notify MD assess ABCS, do vitals advise MD for fluid bolus (as per medical orders) no more NITRO! do a right-sided ECG

500

My patient is having a massive anterolateral MI. They are vitally stable. I am waiting for the cath lab team/transport team to arrive. I notice the patient becomes unresponsive and the monitor shows vfibb What will I do?

What is : call CODE BLUE, call for help start compressions assisted ventilation (BVM) ensure PADs are on, connected to DEFIB machine prepare epinephrine, amiodarone