What are the Inferior leads?
What are the Lateral leads?
What are the Anterior leads?
- Inferior: II, III, aVF
- Lateral: I, aVL, V5, V6
- Anterior: V1-V4
What are some classic EKG findings in STEMI?
- ST segment elevation 1 mm in two or more continguous leads
- Q waves
What are some classic EKG findings in NSTEMI?
- EKG may be normal (rare)
- ST depression
- T wave inversion (often symmetric)
Finding ST depression in leads separate from the region of ST elevation (increases/decreases) the probability of MI>
increases
Lateral wall MI
- Where is the ST elevation?
- Occlusion of which artery?
- Reciprocal depression where?
- Leads I, aVL, V5, V6
- Left circumflex artery
- Leads II, III, aVF
Inferior wall MI
- Where is the ST elevation?
- Occlusion of what artery?
- Reciprocal depression where?
- Leads II, III, aVF
- Right coronary artery (RCA)
- May have associated RV infarct
- Leads I, aVL
Where is ST elevation most sensitive & specific for a RV MI?
V2R, V3R, V4R
Anterior wall MI
- Where is the ST elevation?
- Occlusion of what artery?
- Reciprocal depression where?
- Leads V1-V4
- LAD
- Inferior leads
Posterior wall MI
- Where is the ST elevation? depression?
- Occlusion of what artery?
- Elevation: V8, V9
- Depression: V1-V4
- RCA or circumflex (depends)
What are the common cardiac medications administered for an MI?
- Aspirin
- Nitroglycerin
- Morphine
- Heparin
- Beta blockers
- Plavix
What medication should you NOT give to a hypotensive patient?
Nitroglycerin
You should give this medication to all patients getting fibrinolytic therapy
Heparin
Fibrinolysis has the greatest benefit when started within ___ hours of onset of pain
3
How do you treat a pulseless VT?
defibrillate ASAP with 200 J
load w/ amiodarone
How do you treat unstable VT?
cardioversion 100-200 J
load w/ amiodarone
What are the main troponins expressed in the heart?
Cardiac troponin I (cTnI)
Cardiac troponin T (cTnT)
What are the main cardiac causes of elevated troponin?
- Heart failure
- Myocarditis
CTn
- Begins to rise:
- Peak:
- Persists for:
- Begins to rise 2-3 hrs after
- Peak around **48 hrs **
- Persists for up to **10-14 days **
CK-MB
- Begins to rise:
- Peak:
- Persists for:
- Beings to rise 4-6 hrs after
- Elevated at 12 hrs
- Retruns to base w/i 36-48 hrs
cTn or CKMB?
- More specific
- Can be used for late diagnosis of MI
- Can detect late infarct
Cardiac troponins
Where are these commonly located?
- Aneurysms
- Dissections
- Aneurysms: abdominal aorta
- Dissection: ascending aorta
What are troponins?
Where are they expressed?
- Cardiac regulatory proteins that control the calcium-mediated interaction of actin & myosin
- cTnI - heart only
- cTnT - heart, skeletal muscle
The diagnosis of acute MI is traditionally relied upon the combination of….
- chest pain
- electrocardiogram manifestations
- elevated biomarkers
- pathology
What is creatinine kinase?
What are the combinations?
What do they do?
- Exist as isoenzymes (dimers of M & B chains)
- CK-MM
- CK-MB
- CK-BB
- Reside in the cytosol & faciliate transfer of high-energy phosphates in and out of mitochondria