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