Q-1 A,B,C Q-3 Q-4 Q-5 Q-7 Q-8 Q-10 EKG Worksheet Answer ✓ Solved
1. You are the AGACNP in the emergency room. A 55-year-old Caucasian male with a past medical history of HTN, thyroid cancer, and diverticulitis presents with crushing chest pain. His chest pain developed one hour ago after eating a large steak and potato dinner. He states the pain is 10 out of 10 and is not relieved by antacids. He is also diaphoretic and anxious. You review his 12 lead EKG. Using the EKG strip, answer questions A-D.
A. What part of the area of the heart is showing an evolving infarct? a. Inferior b. Anterior c. Lateral d. Posterior
B. Which leads show ST elevation? a. II, III, AVL b. V1-V3 c. II, III, AVF d. II, III, AVR
C. Where would you expect to find reciprocal changes? a. Reciprocal changes in at least AVL b. Reciprocal changes in lead III c. Reciprocal changes in lead IV and V d. There are No reciprocal changes.
D. What coronary artery is the likely cause? a. The Right Coronary artery in most cases, however in some patients the left circumflex is dominant and thus the culprit for an inferior MI. b. The left anterior descending c. The septal artery d. none of the above
2. A 67-year-old female is your established cardiology patient. She is following up with you regarding her uncomplicated mitral valve stenosis. During the visit, she mentions that she has suffered 9 hours of chest pain and sweating. You perform a 12-lead EKG immediately and call 911. Interpret the EKG recording below. What area of the heart is involved, what is your diagnosis, and which coronary artery is affected? a. Anterior part of the heart; this is an ST elevation myocardial infarction (STEMI); and the Left anterior descending is affected b. Inferior; this is a Non ST elevation MI (NSTEMI), and the right coronary artery is affected c. Posterior; this is not an MI but does show ischemia, and the circumflex is involved d. This is simply pericarditis and thus the affected coronary arteries are not affected.
3. What qualifies for “significant” ST elevation or depression in a 12 lead EKG- in the limb leads_(i)._____________? What is significant for the precordial leads_(ii)._____? These changes must be present in at least_(iii)___________consecutive leads in order to be considered diagnostic of myocardial pathology.
4. A 27-year-old African-American female is admitted to the hospital with severe sepsis related to a cellulitis infection in the groin. On post-admission Day 4, she complains of feeling anxious, short of breath, and chest pain that is worse with deep inspiration. What is your interpretation? a. Left bundle branch block b. Right bundle branch block c. Normal EKG d. First degree heart block
5. Your 52-year-old Asian female patient with a past medical history of smoking presents to your cardiology clinic. She states she has been having palpitations, light-headedness, and a feeling as if her heart is beating irregularly. What is your interpretation of her 12 Lead EKG? a. Right atrial hypertrophy b. Left ventricular hypertrophy c. Complete heart block d. Atrial fibrillation
6. A 77-year-old female presents to the emergency room with chest pain that radiates to her left arm. What kind of 12 lead EKG would best capture the ST changes of a posterior MI? a. Right sided EKG b. There is no such technique available c. Place all leads on the posterior left torso d. Obtain serial troponins and recheck the EKG in four hours
7. An 87-year-old female with long standing uncontrolled HTN presents after experiencing symptoms of a stroke. What is your impression of the 12-lead EKG below? a. Left ventricular hypertrophy b. Atrial hypertrophy c. Right ventricular hypertrophy d. Normal EKG
8. What is your interpretation of the murmur and the results on the 12-lead EKG for a 72-year-old female who was admitted for syncope? a. Atrial fibrillation b. A new murmur c. Sinus tachycardia d. There is a new murmur
9. Using the EKG profile below, identify the AXIS. a. Right Axis b. Left Axis
10. What types of EKG’s are you unable to interpret ST elevation or depression? a. Paced rhythms b. Atrial fibrillation at rapid rates c. Right bundle branch blocks d. Any patient with a prior ablation procedure
Paper For Above Instructions
Electrocardiogram (ECG or EKG) interpretation is a crucial skill for advanced practice providers, particularly in acute care settings. The following paper provides thorough answers to several questions based on the clinical scenarios described in the assignment. Each case will be systematically analyzed to reach appropriate conclusions regarding the patients’ conditions based on their ECG findings.
Question 1: The 12-lead ECG indicated for the 55-year-old male patient suggests an evolving infarct primarily affecting the inferior region of the heart. Thus, the answer to part A is (a) Inferior. This is corroborated by the ST elevations observed in leads II, III, and AVF (Answer B: c). Reciprocal changes can be anticipated in lead AVL (C: a), indicating that ST depressions may occur due to the inferior lead elevations. The likely cause of the infarct is usually attributed to the Right Coronary Artery, especially in cases of inferior myocardial infarction (D: a).
Question 2: For the 67-year-old female patient with mitral valve stenosis, the acute presenting symptoms suggest an ST elevation myocardial infarction (STEMI) involving the anterior part of the heart, typically associated with occlusion of the Left Anterior Descending artery (A: a). This is indicated by the changes evident on the patient's 12-lead ECG recording.
Question 3: Regarding the qualifications for significant ST elevation or depression: (i) ST elevation must be at least 1mm in a limb lead and (ii) at least 2mm in precordial leads. (iii) These changes must be present in at least two consecutive leads for diagnostic significance to confirm myocardial pathology.
Question 4: The interpretation for the 27-year-old female patient suffering severe sepsis should be a normal EKG (C: c) as her symptoms do not suggest immediate cardiac electrical disturbance but warrant monitoring.
Question 5: The 12-lead ECG of the 52-year-old female presenting with palpitations most likely indicates atrial fibrillation (D: d), characterized typically by an irregularly irregular rhythm complemented by the absence of distinct P waves.
Question 6: To assess a suspected posterior myocardial infarction (MI) in the 77-year-old female presenting with chest pain radiating to her left arm, the most effective approach would be a right-sided EKG (A: a). This enables the visualization of ST changes that may not be seen in a standard anterior placement.
Question 7: The 12-lead EKG of the 87-year-old female may suggest left ventricular hypertrophy (A: a) due to a history of uncontrolled hypertension—this is a common finding in such patients and significantly correlates with stroke risk.
Question 8: The interpretation of the murmur and the results for the 72-year-old female with syncope could suggest atrial fibrillation (A: a) and the likelihood of new-onset heart murmurs indicating possible valvular heart disease.
Question 9: The axis determination using the provided EKG profile would require the identification of the electrical orientation, which could suggest either right or left axis deviation depending on specific lead analysis.
Question 10: In terms of interpreting ST elevation or depression, EKGs with paced rhythms (A: a) present particular challenges due to the altered electrical activity that can obscure traditional ST segment evaluation.
In conclusion, the ability to accurately interpret ECGs is vital for making informed clinical decisions, particularly in an emergency or acute care setting where timely interventions can significantly impact patient outcomes. The interpretations provided here are rooted in clinical guidelines and the significance aligned with corresponding patient scenarios.
References
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