Question | Answer |
Waht is electical reciprocity? | ST elevations in one group on the ECG will show up as ST depressions in the other. Not ischemia – “mirroring”. |
Which areas of the heart show reciprocal changes to one another? (2) | 1. Inferior and Lateral
2. Septal and Posterior |
So which leads are reciprocal to the Inferior and Lateral areas of the heart? | ll, lll, and AVF (Inferior) with l, AVL, V5, and V6 (Lateral) |
So which leads are reciprocal to the Septal and Posterior areas of the heart on a normal 12 lead ECG? | N/A (there are no posterior leads on a normal 12 lead ECG.) |
True or false? The septal leads can mirror the activity in the posterior portion of the heart. | True |
How might you get a rough, preliminary view of the electrical activity in the posterior portion of the heart? | Look at the septal leads (Vl and V2)backwards and upside down with good lighting behind the image. |
How do you get the best view of the electrical activity in the posterior portion of the heart? | Perform a right sided 12 lead ECG. |
When would you need to do a right sided ECG in order to view the electrical acivity of the posterior portion of the heart? | If there are changes in the septal leads (Vl and V2), especially if there are ST Elevations in the inferior leads (ll,lll,and AVF)and ST Depressions in the septal leads. |
Why would you need to do a right sided ECG if there are ST Elevations in the inferior leads (ll,lll,and AVF)and ST Depressions in the septal leads | Because if the inferior portion of the heart is infarcted the posterior portion may also be. (Remember that the inferior and posterior heart areas are both fed by the RCA.) |
How do you correctly apply the electrodes for a right sided ECG? | Apply the electrodes the same as you did on the left, but instead put them on the right. Add 3 more electrodes after V6 (V7,8, and 90 using the same spacing as the other electrodes have and keeping in line with V5 and V6 (along the 5th intercostal space.) |
Where is the Vl wire attached? | To the 4th electrode. |
Where are the rest of the wires attached? | The V2 wire goes on the V5 electrode, V3 wire on the V6 electrode and so on. |
What is it called when both the inferior and posterior portions of the heart are being infarcted? | A right ventricular MI (RVMI) |
What happens to the right ventricle during a RVMI? | It becomes hypokinetic (it doesn't move much.) |
What do you do for a patient with a RVMI? | Give a lot of isotonic IV fluids! Liters and liters...maybe 10 or more in a day!! (maintain a blood pressure) |