EKG Final Exam (thank god it's almost over)

T/F The presence of electrocardiographic changes is a better measure of clinically significant potassium toxicity than the serum potassium level

True

How does T-wave peaking differ with myocardial infarctions and hyperkalemia?

The changes in an infarction are confined to those leads overlying the area of the infarct; hyperkalemia the changes are global

With a further increase in serum potassium, what happens?

PR interval becomes prolonged, P wave flattens then disappears

What is the final development on the EKG with hyperkalemia?

QRS merges with T wave to form a
sine wave pattern

What may eventually develop with hyperkalemia?

V-fib

Do these changes (sine wave form, flattening of T wave) always come in order with hyperkalemia?

No (they often do, but not always)

T/F Any change in the EKG due to hyperkalemia isn't serious

FALSE; it requires immediate attention

With hypokalemia, what changes appear on the EKG?

ST segment depression, flattening of T wave, appearance of U wave

With hyperkalemia, what changes appear on the EKG?

T wave peaking, P wave flattening and disappearance, and sine waves

T/F U waves have the same axis as T waves

True

What other conditions can produce U waves?

CNS Dz and some antiarrhythmic drugs

T/F U waves can sometimes be seen in pt with healthy hearts and normal serum potassium levels

True

Hypocalcemia ___________ the QT interval

prolongs

Hypercalcemia _________ the QT interval

shortens

Hypocalcemia is associated with

Torsades de Pointes

Characteristics of hypothermia (<30C) on the EKG?

Sinus bradycardia, prolonged segments and intervals, J wave/Osborn waves, slow atrial fib (any rhythm can occur), and muscle tremor artifact due to shivering

What is the digitalis effect?

ST segment depression with flattening or inversion of the T wave

The ST segment seen in the digitalis effect is often akin to...

ventricular hypertrophy with depolarization abnormalities (it isn't symmetrical)

Ischemia ST segment depression is...

symmetrical

Digitalis is often used in patients with...

CHF w/ LVH

T/F The digitalis effect is normal and predictable and does not necessitate discontinuing the drug

True

T/F The digitalis effect is most prominent in leads with small R waves

FALSE; tall R waves

What can digitalis intoxication lead to?

First, second, and third degree AV blocks and tachyarrhythmias

T/F With therapeutic blood levels of digitalis, the sinus node can be slowed, especially pt with sick sinus syndrome

True

At toxic blood levels of digitalis, what kinds of sinus node suppression occur?

Sinus exit block or complete sinus node suppression

T/F Digitalis slows conduction through the AV node

True

Since digitalis can slow the AV node, what can it be used to treat?

SVTs

T/F Digitalis is better used to slow the heart rate during exertion rather than beta-blockers like metoprolol

False; its effect is commonly lost during exertion

T/F Digitalis enhances the automatic behavior of all conducting cells

True

T/F Digitalis can cause any tachyarrhythmia

True

What are the most common tachyarrhythmias associated with digitalis?

PAT and PVCs

What are the least common tachyarrhythmias associated with digitalis?

Atrial flutter and fibrillation

What is the most characteristic rhythm disturbance of digitalis intoxication?

PAT with second-degree AV block (2:1, digitalis is the most common reason for this type of block but not the only)

What are some medications that prolong the QT interval?

Sotalol, quinidine, procainamide, disopyramide, amiodarone, dofetilide, dronedarone, tricyclic antidepressants, phenothiazines, EEY, quinolones, antifungals

T/F Antiarrhythmic drugs must be stopped if the QT interval increases by 20%

FALSE; more than 25%

A common cause of an inherited disorder that is associated with long QT intervals is...

a mutation in a gene that encodes pore-forming subunits on membrane that generates a slow K+ current that is adrenergic sensitive

How do you treat inherited disorders of cardiac repolarization associated w/ long QT intervals?

Beta-blockers and implantable defibrillators, sometimes left cervical-thoracic sympathetic denervation

T/F Children with inherited disorders associated with long QT intervals are at great risk for sudden death

True

How do you measure the QT interval accurately?

T/F The QTc should not exceed 500 ms during therapy with any medication that can prolong the QT interval

True

T/F The QTc should not exceed 550 ms during therapy with any medication that can prolong the QT interval w/ BBB

True

When is Bezett's formula the most accurate?

At heart rates between 50-120 bpm

What effects does pericarditis have on an EKG?

Diffuse ST segment elevation and T wave flattening/inversion

Can the PR interval sometimes be depressed in pericarditis?

Yes

T/F you can see Q waves with pericarditis

FALSE

In pericarditis, when do you usually see T wave inversion?

When the ST segments have returned to baseline

In infarction, when do you see T wave inversion?

It precedes normalization of the ST segments

What does pericardial effusion do?

Dampens the electrical output -->
low voltage in all leads

What causes electrical alternans?

When an effusion is large and rotates freely

What does electrical alternans effect?

The axis of QRS complexes and P and T waves

IHSS (HOCM) EKG changes?

Mostly normal EKGs with LVH or LAD, sometimes Q waves

What are the most common EKG changes with somebody suffering from myocarditis?

BBB and hemiblocks

T/F The EKG of a patient with long-standing emphysema may show low voltage, RAD, and poor R wave progression in precordial leads

True

Why is there low voltage seen in patients with emphysema?

The expanded residual volume of air trapped in the lungs

What is RAD caused by with patients with emphysema?

Pressure overload hypertrophy from pulmonary HTN and forcing the heart into a vertical or rightward position

What can COPD lead to?

Chronic cor pulmonale and right-sided CHF

What does the EKG look like in patients with COPD?

Right atrial enlargement (p pulmonale) and RVH w/ repolarization abns

How can a PE affect the EKG?

RVH w/ repolarization abn, RBBB, S1Q3, sinus tach/a-fib

T/F The T wave in lead III w/ PE can be inverted

True

T/F The Q waves in an acute PE are limited to lead III

True

T/F The EKG in a patient w/ non massive pulmonary embolism still displays these changes

False; it is mostly normal or can show sinus tach

CNS catastrophes like subarachnoid bleed or cerebral infarction display what EKG changes?

Diffuse and deep/wide T wave inversion and prominent U waves, sinus bradycardia

T/F The T waves seen with CNS diseases are asymmetrical

False

What is the most common cause of sudden cardiac death?

Underlying atherosclerosis (CAD) triggering infarction and/or arrhythmia

What are some other causes of sudden cardiac death?

Long QT interval syndrome, IHHS, arrhythmogenic right ventricular dysplasia, WPW, viral myocarditis, valvular heart disease, amyloidosis/sarcoidiosis, drug abuse, commotio cordis, Brugada syndrome, anomalous origin of coronary arteries

What is commotio cordis?

V-fib triggered by blow to the anterior chest wall

What are some infiltrative diseases of the myocardium?

Amyloidosis and sarcoidosis

What is arrhythmogenic right ventricular dysplasia?

A heritable cardiomyopathy w/ fibrofatty infiltration of right ventricular myocardium

What is anomalous origin of the coronary arteries?

Constriction of the artery by surrounding tissue causes V-fib

T/F Brugada syndrome occurs in structurally normal hearts

True

T/F Brugada syndrome is much more common in women in their 20s and 30s than men

FALSE; more common in men in 20s-30s

What causes Brugada syndrome?

An autosomal dominant trait where the mutation affects voltage-dependent Na channels of repolarization

What kind of EKG abnormalities are associated with Brugada syndrome?

RBBB and ST segment elevation in V1, V2, and V3

Brugada syndrome usually brings upon what ventricular arrhythmia?

Poly V-tach that resembles Torsades

T/F Sudden death by Brugada syndrome is most likely to occur during exercise

False; during sleep

T/F Beta blockers can help somebody with Brugada syndrome

False; implantable cardiac defibrillators are helpful

EKG changes associated with athlete's heart

Resting sinus brady (<30), ST segment elevation in precordial leads with T wave flattening or inversion, LVH, SOMETIMES RVH, incomplete RBBB, junctional rhythms and wandering atrial pacemaker, first-degree, Wenckebach

T/F Athletes are at an increased risk of sudden death due to disorders of the heart muscle and sudden ventricular arrhythmias

True

What are some clinical signs of CNS disorders?

Cheyne-Stokes respiration and Cushing's Triad

What is Cushing's Triad?

What is Cheyne-Stokes respiration?

an abnormal pattern of breathing characterized by periods of breathing with gradually increasing and decreasing tidal volume interspersed with periods of apnea. In cases of increasing intracranial pressure, it is often the first abnormal breathing pattern

T/F With CNS disorders, EKG changes are thought to be due to affects on the autonomic nervous system

True

What are some causes for an acute PE?

DVT, fat, amniotic fluid, air, methymethacrylate

Treatments for acute PE?

Thrombolytics, anti-coagulants, pulmonary thrombectomy

What are some clinical signs of acute PE?

Low EtCO2 and BP, high HR

What is the main risk factor for COPD?

Smoking (15%)

How else can you develop COPD?

Dusty environments, alpha 1-antitrypsin deficiency, byssinosis, idiopathic dz

Causes of myocarditis?

Viral/bacterial infection, transplant rejection, chemo, snake venom, carbon monoxide, arsenic

Symptoms of IHSS?

Syncope, angina, DOE

Symptoms of pericarditis?

Pericardial rub and Beck's Triad

What is Beck's Triad consist of?

Digitalis works by inhibiting what?

Sodium-potassium ATPase which increases intracellular calcium

Digitalis does what?

Strengthens cardiac contractility and controls HR

Symptoms of digitalis toxicity?

Anorexia, nausea, vomiting, diarrhea, xanthopsia, halos, bradycardia

T/F Osborne waves are distinctive ST elevation consisting of an abrupt ascent right at the J point and then a plunge back to baseline

True

When is carotid massage needed?

PSVT

Carotid massage increases the block in what arrhythmia?

Atrial flutter

What are the four basic types of arrhythmias?

Arrhythmias of sinus origin, ectopic rhythms, conduction blocks, preexcitation syndromes

T/F PSVT is usually seen in normal hearts

True

T/F VT is usually seen in diseased hearts

True

T/F Carotid massage has an effect on MAT

False

What is the criteria for non-q wave infarctions?

T wave inversion and ST segment depression persisting for more than 48 hours

For a posterior infarction, what do you look for?

Reciprocal changes in lead V1 (ST segment depression, tall R wave)

What are abnormal findings in athlete's heart?

T-wave inversion beyond lead V2 in white athletes and beyond V4 in African American/Caribbean athletes; ST-segment depression in any lead; findings consistent with congenital heart disorders (ie: WPW)

T/F The presence of RAD may be an important clue that the wide QRS complexes are the result of hyperkalemia and not something else.

True

With hypokalemia, where can you best see u waves?

anterior leads

A short QT interval is generally defined as less than...

360 ms

What else can cause low voltage besides pericardial effusion?

The expanded air-filled lungs of chronic lung disease, Pneumothorax, Large pleural effusion, The marked adiposity of a very obese patient

The crochetage pattern is indicative of what...

atrial septal defect (or PFO or normal hearts)

Which arrhythmia has an epsilon wave?

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

T/F If patients require ?-blockers, calcium channel blockers, or nitrates before surgery, continue them into the operative and post-op period.

True

Beta-blockers reduce what?

Post-operative ischemia

Auscultatory areas

aortic, pulmonic, erb's point, tricuspid, mitral

S1 indicates the beginning of ________ and closure of what valves

systole, AV valves

S1 is best heard at

apex

S2 is best heard at

aortic and pulmonic areas

S2 indicates ____ of systole and closure of what valves

end, semilunar valves

S3 indicates passive filling of

ventricles

Which basic heart sound is quiet, low-pitched, and hard to hear?

S3

S4 occurs due to...

vigorous atrial contraction

Murmurs are caused by

disturbance in the flow of blood into, through, or out of heart

Characteristics of a murmur depend on...

valve function, size of opening, rate of BF, vigor of myocardium, thickness of tissue

What can an echocardiogram be used for?

Produce accurate assessment of velocity of blood and cardiac tissue

Types of echocardiography

trans thoracic, exercise stress echo, dobutamine, TEE

T/F Each cycle of cardiac contraction and relaxation is initiated by spontaneous depolarization of the SA node.
This event is NOT seen on the EKG

True

T/F There is a brief pause when the electrical current reaches the AV node and the EKG falls silent

True (PR segment)

What is the first part of the ventricles to be depolarized?

Interventricular septum

T/F Atrial repolarization is seen on the EKG

False (ventricular repolarization is)

T/F A wave of repolarization moving away from a positive electrode inscribes a positive deflection on the EKG

FALSE (negative)

T/F To prepare a patient for a 12-lead EKG, two electrodes are placed on the arms and two on the legs

True

The limb leads view the heart in what plane?

Frontal plane

Why are the augmented leads called augmented leads?

The EKG machinery must amplify the tracings to get an adequate recording

T/F Leads II, III, and aVF are the leads that view the portion of the heart that rests on the diaphragm

True

The six precordial leads are in what plane?

Horizontal plane

To create the six precordial leads, each chest electrode is made ________

positive

T/F The leads of the frontal plane view electrical forces moving up and down and left to right while the precordial leads record forces moving anteriorly and posteriorly

True

T/F V1 is placed in the fourth intercostal space to the left of the sternum

FALSE (that is V2!)

T/F V2 is placed in the fourth intercostal space to the left of the sternum

True

V4 is placed where?

The fifth intercostal space in the midclavicular line

V6 is placed where?

The fifth intercostal space in the midaxillary line

T/F The vector's angle of orientation represents the average direction fo current flow and its length represents the voltage (amplitude) attained

True

T/F The right atrium depolarizes first, then the left atrium

True

T/F The amplitude of the P wave does not normally exceed 0.25 mV in any lead due to the atria being small

True

T/F If the P wave in lead III changes from biphasic to negative, it indicates some sort of pathology

False (can be seen in healthy hearts)

T/F The PR interval normally lasts from 0.15 to 0.2 seconds

False (0.12-0.2 s)

T/F Regarding ventricular depolarization, the inter ventricular septum depolarizes first in a right-to-left direction

False (left-to-right)

T/F The septal fascicle is responsible for delivering the wave of depolarization to the interventricular septum

True

T/F Normal septal Q waves have an amplitude of not greater than 0.1 mV

True

What is the normal duration of a QRS interval?

0.06-0.1 seconds

T/F The ST segment is usually horizontal or gently upsloping in ALL leads

True

T/F Repolarization requires a great deal of cellular energy and the T wave is highly susceptible to all kinds of influence

True

T/F It is typical and normal to find positive T waves in the same leads that have short R waves

False (tall R waves)

T/F The amplitude of a normal T wave is one-third of the corresponding R wave

False (1/3-2/3)

The QT interval comprises what percentage of the normal cardiac cycle?

40%

T/F The faster the heart beats, the faster it must repolarize for next contraction, so the QT interval lengthens

False (shortens QT interval)

The P wave is the most positive in what lead?

II

The term hypertrophy refers to

an increase in muscle mass

What is most hypertrophy caused by?

Pressure overload

T/F Pressure overload refers to when the heart is forced to pump blood against an increased resistance (HTN/aortic stenosis)

True

Enlargement of the heart refers to...

dilatation of a chamber

Enlargement is caused by...

volume overload

T/F Enlargement is most often seen with valvular dz

True

T/F Mitral insufficiency may cause left ventricular enlargement

FALSE (left atrial enlargement)

T/F Enlargement and hypertrophy rarely coexist

False

T/F The EKG is sufficient in distinguishing between hypertrophy and enlargement

False

T/F The mean QRS vector points leftward and inferiorly

True

The normal QRS axis lies between

+90 and 0 (don't say +90 to -30 because Mudd is Mudd)

T/F The normal P wave axis lies between 50 to 60 of the QRS axis

False (0-70)

T/F The T wave axis lies from 50-60 of the QRS axis

True

T/F RVH is commonly seen in patients with pulmonary dz

True

Which leads do you look at to assess atrial enlargement?

II and V1

T/F With right atrial enlargement, the amplitude of the first portion of the P wave increases

True

T/F With enlargement of the right atrium, the tallest P wave may now be in aVF or III

True

Right atrial enlargement is associated with

P pulmonale

For left atrial enlargement...

The amplitude of the terminal component of P wave may be increased and must descend at least 1 mm below the isoelectric line in V1
The duration of the P wave is increased, and the terminal portion of the P wave must be 0.04 s in width

T/F Atrial enlargement can include possible RAD of the P wave

True

T/F EKG evidence of atrial enlargement often has no pathological correlation

True (besides COPD)

For assessing LVH, the R wave amplitude in lead V5 must exceed

26 mm

For assessing LVH, the R wave amplitude in lead V6 must exceed

18 mm

For assessing LVH, the R wave amplitude in lead V5 or V6 plus S wave amp in lead V1 or V2 exceeds...

35 mm

T/F The precordial leads are more sensitive for assessing LVH

True

T/F For assessing LVH, the R wave amplitude in lead aVL exceeds 13 mm

True

T/F For assessing LVH, the R wave amplitude in lead aVL exceeds 21 mm

True

T/F For assessing LVH, the R wave amplitude in lead I exceeds 14 mm

True

T/F The R wave amplitude in lead I plus the S wave amplitude in lead III exceeds 34 mm

False (25 mm)

What are the leading causes of LVH?

Systemic HTN and valvular dz, aortic stenosis

T/F Both LVH and RVH slightly prolong the QRS complex but usually not enough to notice

True

What are the key characteristics of secondary depolarization abnormalities?

Down-sloping ST segment depression and T wave inversion

RV abn are seen in leads

V1 and V2

LV abn are seen in leads

I, aVL, V5, V6

Why arrhythmias happen

Hypoxia, Ischemia/Irritability, Sympathetic stimulation, drugs, electrolyte disturbances, bradycardia, stretch

T/F Event monitors are superior to Holter monitors for detecting rhythm disturbances

True

T/F Inspiration slows the heart rate

False (accelerates the heart rate)

T/F Sinus arrest occurs when the sinus node stops firing

True

T/F Atrial pacemakers discharge at a rate of 60-75 bpm

True

Which pacemaker cells are located near the AV node and at what rate do they fire?

junctional pacemakers, 40-60 bpm

T/F Ventricular pacemaker cells discharge at 30-45 bpm

True

T/F Junctional escape is the most common type of escape beat

True

T/F With junctional escape, depolarization originates near the AV node and atrial depolarization does not occur

True

How do ectopic rhythms differ from escape beats?

They are sustained

T/F The fastest pacemaker is the SA node

True

What are the most common causes of enhanced automaticity?

Digitalis toxicity and beta-adrenergic stimulation

Impulse transmission refers to

reentrant rhythms

T/F Reentrant loops can either be confined to a single anatomic site or both an atrium and ventricle

True

T/F Atrial arrhythmias can consist of a single beat or a sustained rhythm disturbance lasting for a few seconds or many years

True

Why is the contour of the P wave different in a premature atrial contraction?

Because the beat originates at an atrial site distant from the SA node

T/F Both junctional and atrial premature beats are usually conducted normally to the ventricles

True

T/F PSVT occurs in dying hearts

False (healthy hearts)

Is PSVT regular or irregular?

Regular

What can help diagnose and terminate an episode of PSVT?

Carotid massage

How do baroreceptors sense changes in blood pressure and how does this slow conduction through the AV node?

When BP rises, baroreceptors send reflex responses along the vagus nerve to the heart. Vagal input decreases the rate at which the sinus node fires

T/F Anything that raises blood pressure will stimulate vagal input to the heart

True

What is most commonly the underlying mechanism of PSVT?

Reentrant circuit

T/F when performing a carotid massage, you should compress both arteries simultaneously

False

T/F You should try the left carotid side first when performing a carotid massage

False

Adenosine blocks...

the AV node

All PSVT treatments

Carotid massage, Valsalva, squatting, adenosine, beta-blockers, calcium channel blockers, sometimes electrical cardioversion

T/F Atrial flutter can occur in healthy hearts

True

How many bpm do the P waves appear in atrial flutter?

250-350 bpm

The most common form of atrial flutter arises from a...

reentrant circuit that runs around annulus of tricuspid valve

T/F Carotid massage may decrease the degree of block

False (it increases so you can identify the saw-toothed pattern)

T/F The axis of P waves in atrial flutter depend on whether the circuit rotates counterclockwise or clockwise

True

What are some causes of atrial flutter?

HTN, obesity, DM, electrolyte imbalances, alcohol intoxication, drug abuse, pulmonary dz, thyrotoxicosis, cardiac issues

Is electrical cardio version effective with atrial flutter?

Yes

T/F atrial fibrillation is considered an irregularly irregular rhythm

True

Which is more common: Atrial flutter or A-fib?

A-fib

T/F Most pt with A-fib are asymptomatic

False (palpitations, chest pain, SOB, dizziness)

How to restore normal sinus rhythm with A-fib?

Electrical/pharmacologic cardioversion, ablation, beta-blockers

T/F Patients with persistent A-fib are at high risk for blood clots

True

T/F MAT is a regular rhythm

False

T/F MAT occurs at a rate of 100-200 bpm

True

Where is MAT common?

Lung dz

T/F MAT rarely requires treatment

True

T/F PAT is a regular rhythm with a rate of 100-200 bpm

True

How does PAT arise?

Enhanced automaticity of an ectopic atrial focus or reentrant circuit in atria

T/F PAT is most commonly seen in normal hearts

True

What else can PAT be caused by?

Digitalis toxicity

Warming up and cooling down periods is associated with

PAT

T/F Carotid massage may slow down the ventricular rate with A-fib

True

what is the atrial rate in A-fib?

350-500 bpm

What is the most common ventricular arrhythmia?

PVCs

T/F You must have a 12 lead EKG to diagnose for a PVC

True

T/F An interpolated PVC is a PVC that occurs between two normally conducted beats without a pause

True

What are the rules of malignancy?

Frequent PVCs, runs of PVCs (3+), multiform PVCs, PVCs falling on T wave, PVCs in setting of AMI

T/F The rate for V-tach is slightly irregular

True

What must be performed for patients with V-fib?

Resuscitation and defibrillation

What are some common precipitants of V-fib?

MI, hypercapnia, electrolyte imbalances, stimulants

T/F A wide QRS can either signify a beat originating within the ventricles or a supra ventricular beat conducted aberrantly

True

T/F A fusion beat occurs when an atrial impulse manages to slip through the AV node at the same time that an impulse of ventricular origin is spreading across the myocardium

True

T/F Ashman phenomenon describes a wide, aberrantly conducted supra ventricular beat occurring after a QRS complex that is preceded by a long pause

True

T/F An AV block refers to any conduction block between the sinus node and the Purkinje fibers

True

T/F A routine 12-lead EKG is good at distinguishing between a block in the AV node and one in the His bundle

False

T/F First-degree AV block is associated with an increased risk of a-fib, the need for pacemaker insertion, and all-cause mortality

True

First-degree AV block may be indicative of...

degenerative dz, myocarditis, drug toxicity

T/F Wenckebach block is almost always due to a block within the AV node

True

T/F Mobitz type II is usually due to a block below the AV node in the His bundle

True

T/F Conduction in a Mobitz type 2 block is an all-or-nothing phenomenon

True

T/F Third-degree heart block occurs at either the AV node or lower

True

T/F With third-degree heart block, there may be a delay in the appearance of a ventricular escape rhythm

True

T/F A common cause of complete heart block is Lyme Dz

True

T/F LBBB is rare

True

T/F The critical rate is when a bundle branch block only appears at a particular heart rate

True

T/F A nonspecific intraventricular conduction delay occurs when there is a QRS widening greater than 0.10 seconds without other criteria for blocks

True

T/F 1/3 of MIs are silent

True

T/F Epicardial pacing enhances left ventricular conduction and reduces the symptoms of heart failure

True

Epicardial pacing benefits patients with...

LBBB

T/F If you are examining an EKG from a pt unknown to you that demonstrates wide QRS complexes and LAD, you must always suspect the presence of a pacemaker

True (even if the tiny pacemaker spikes cannot be seen)

T/F The QRS complex in WPW actually represents a fusion beat

True

T/F In LGL, the accessory pathway bypasses the delay within the SA node

False (within AV node)

T/F In many individuals with WPW or LGL, preexcitation poses serious issues

False

What are the two tachyarrhythmias most often seen in WPW?

Paroxysmal supra ventricular tachycardia and a-fib

T/F Antidromic tachycardia generate a narrow QRS complex

False

T/F Sometimes there can be more than one accessory pathway in patients with WPW

True

T/F A-fib with WPW is common

False

T/F The sudden and total occlusion that precipitates infarction is usually due to superimposed thrombus or coronary artery spasm

True

What are some features of infarction?

Crushing substernal chest pain radiating to jaw, shoulders, left arm, nausea, diaphoresis, SOB

T/F Patients with DM have exacerbated symptoms of MI

False

T/F After infarction, CK levels return to normal within 48 hours

True

T/F Obtaining serial cardiograms is necessary if you expect an MI

True

T/F Most myocardial infarctions generate Q waves

False

T/F Initially with a MI, the T waves become tall and wide and a few hours later they invert

False (they become narrow)

T/F T wave inversion by itself is indicative only of ischemia and is not diagnostic of MI

True

T/F T wave inversion with ischemia is asymmetrical

False

T/F ST segment elevation signifies myocardial injury

True

What does persistent ST segment elevation indicate?

Ventricular aneurysm

T/F J point elevation is indicative of MI

False (common in healthy individuals but can be confused with myocardial injury)

T/F For a Q wave to be pathologic, it must be greater than 0.08s in duration and it must be at least 1/3 the height of the R wave in the same QRS complex

False (0.04 s in duration)

T/F The left main artery divides into the LAD and left circumflex artery

True

T/F The circumflex artery runs between the left atrium and left ventricle and supplies the posterior wall of the left ventricle

False (lateral)

What is a way to greatly enhance the diagnosis of a MI?

15-lead EKG

T/F for inferior infarcts, reciprocal changes are seen in the anterior leads

False (seen in anterior AND left lateral leads)

T/F Significant Q waves will always persist for the lifetime of the patient

False (not with inferior infarctions, 50% of patients lose this criteria)

T/F For lateral infarctions, reciprocal changes are seen in the inferior leads

True

Which infarction is associated with poor R wave progression?

Anterior infarction

T/F In normal hearts, the amplitude of the R waves should increase at least 1 mV per lead as you progress from V1 to V4

True

T/F To identify a posterior infarction, you must look for ST segment depression and tall R waves in V1

True

Why do inferior and posterior infarctions often occur together?

They share the same blood supply

T/F Non-Q wave infarctions have a higher initial mortality rate and a higher risk for later infarction than Q wave infarctions

False

T/F Troponin levels are also elevated in patients with Apical Ballooning Syndrome

False (i guess it can be...)

T/F There are no ways to distinguish a non-Q wave infarction from angina

False

T/F With a non Q wave infarction, ST segments remain down for at least 48 hours

True

Which angina is associated with ST segment elevation?

Prinzmetal's

T/F Typical angina is usually brought on by coronary artery spasm

False

T/F In the setting of LBBB, the presence of ST segment elevation of at least 1mm in any lead with tall R wave is suggestive of an MI

true

What are some ways to increase the sensitivity and specificity of the exercise test?

Echocardiogram and radioactive imaging agents

T/F Adenosine produces transient coronary vasoconstriction

False (vasodilation)

T/F A severe diastolic blood pressure is considered anything over 110

True

Aortic area auscultory area

2ICS-RSB

Pulmonic area

2ICS-LSB

Tricuspid area

LLSB

Mitral area

5ICS-MCL

Erb's Point

3ICS-LSB