Other than the type of heart blocks and atrial flutter, v-fib and v-tach, how much EKG stuff do we need to know?

Do we have to be able to calculate axes and right or left shift?

For Step 1, no. All I've ever seen is a single-lead strip so no axis determination is possible. Afib and heart blocks are the biggies.

For Step 1, no. All I've ever seen is a single-lead strip so no axis determination is possible. Afib and heart blocks are the biggies.

Hey thanks a lot. That saves me a lot of time in my review... :D

I thought the same as above, and then yesterday on my test there was a multi lead strip that asked which artery the infarction occured in :(. I just picked LAD and moved on ...

hmm how would you aproach such a question. THe only thing i can think of ie if it was like heart block you could think RCA since that supplies AV node. or Afibb coudl be RCA since it supplies SA node. and a wide QRS would be bundle branch block so would be vent septum and thus LDA. Or vent fibb would be lda.. Is that how you go about it?

woah, this is stuff u see on the floors. I mean you have to be somewhat proficient at reading EKG's, knowing which leads supply which part of the heart, and be able to recognize that, and then apply the blood supply to that area. That's def. stuff I barely got acquainted to after doing 2 mos of IM...hmm

Infarct localization is quite easy.

II, III, aVF - inferior MI (form a letter "L" for "low")
V1 only - septal
V2, V3, V4 - anterior
I, aVL, V5, V6 - lateral
II, III, aVF and V1 looking like an upside-down MI - posterior
I and aVL only - high (superior) lateral

These can also combine. E.g. V1-V4 anteroseptal; I, aVL, V3-V6 anterolateral, etc.

To very grossly generalize (coronary anatomy is quite variable):

RCA supplies the posterior wall.
LAD supplies the anterior wall.
Circumflex supplies the lateral wall.
Inferior wall could be RCA or LAD
Since circumflex comes off the LAD, a high LAD occlusion will take out both vessels and cause anterolateral MI. An osteal occlusion will also involve the septal perforators and grab the septum along for the ride.

Infarct localization is quite easy.

II, III, aVF - inferior MI (form a letter "L" for "low")
V1 only - septal
V2, V3, V4 - anterior
I, aVL, V5, V6 - lateral
II, III, aVF and V1 looking like an upside-down MI - posterior
I and aVL only - high (superior) lateral

These can also combine. E.g. V1-V4 anteroseptal; I, aVL, V3-V6 anterolateral, etc.

To very grossly generalize (coronary anatomy is quite variable):

RCA supplies the posterior wall.
LAD supplies the anterior wall.
Circumflex supplies the lateral wall.
Inferior wall could be RCA or LAD
Since circumflex comes off the LAD, a high LAD occlusion will take out both vessels and cause anterolateral MI. An osteal occlusion will also involve the septal perforators and grab the septum along for the ride.

ya that sounded really easy thanks

Also, RCA infarcts tend to cause bradycardia and heart block because of hypervagatonia (has to do with where vagal fibers run anatomically). Inferior wall MI's can present with stomach ache, nausea, and vomiting as the primary complaints.