Medicine Marrow Pg No 417-426 (ECG)
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Questions and Answers

Which of the following is NOT part of the right coronary circulation?

  • Lateral wall MI (correct)
  • Posterior wall MI
  • Inferior wall MI
  • Right ventricular MI
  • Left dominant coronary circulation is more common than right dominant coronary circulation.

    False

    What leads correspond to inferior wall myocardial infarction?

    II, III, AVF

    Most individuals have a ______ dominant coronary circulation.

    <p>right</p> Signup and view all the answers

    Match the following terms with their corresponding descriptions:

    <p>Right Coronary Artery = Supplies the right side and inferior walls of the heart Left Coronary Artery = Supplies the left anterior and lateral walls Posterior Descending Artery = Determines coronary dominance Left Atrium = Located on the posterior surface of the heart</p> Signup and view all the answers

    What is the primary mechanism of hibernation in myocardium?

    <p>Chronic</p> Signup and view all the answers

    Stunning of the myocardium is characterized by chronic ischemic dysfunction.

    <p>False</p> Signup and view all the answers

    What investigation is preferred to differentiate between ischemia and infarction?

    <p>FDG-PET</p> Signup and view all the answers

    The target LDL cholesterol level for statin therapy is greater than ______ mg/dL.

    <p>190</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Ischemia = Condition of reduced blood flow Hibernation = Chronic persistent ischemic dysfunction Stunning = Acute transient dysfunction post-reperfusion Statins = Medications to lower LDL cholesterol</p> Signup and view all the answers

    What consequence is associated with proximal RCA occlusion?

    <p>Sinus bradycardia</p> Signup and view all the answers

    Distal RCA occlusion is associated with RVMI.

    <p>False</p> Signup and view all the answers

    What is the role of the acute marginal artery?

    <p>It supplies the right ventricular free wall.</p> Signup and view all the answers

    Proximal RCA occlusion can result in _____ arrhythmias.

    <p>atrial</p> Signup and view all the answers

    Match the following types of RCA occlusions with their effects:

    <p>Proximal Right Dominant = RVMI + IWMI Distal Right Dominant = IWMI Proximal Left Dominant = RVMI Distal Left Dominant = No MI</p> Signup and view all the answers

    Which of the following T wave characteristics indicates a potentially serious condition?

    <p>Tall/peaked T wave</p> Signup and view all the answers

    The presence of U waves in an ECG trace is commonly associated with hyperkalemia.

    <p>False</p> Signup and view all the answers

    What does ST depression in an ECG typically indicate?

    <p>Ischaemia or stress on the heart</p> Signup and view all the answers

    The ECG analysis shows recordings at ____ minutes to observe ST depression changes.

    <p>60, 90, and 120</p> Signup and view all the answers

    Match each type of T wave characteristic to its description:

    <p>Normal myocardium = Unaffected T wave Tall/peaked T wave = Can indicate hyperkalemia Deep symmetrically inverted T wave = Often associated with ischaemic conditions U wave = Possible indicator of hypokalemia</p> Signup and view all the answers

    What is a necessary criterion for diagnosing a myocardial infarction (MI)?

    <p>Reciprocal changes must be present</p> Signup and view all the answers

    ST elevation in leads V1 to V3 should be ≥1.5mm in females to be considered significant.

    <p>True</p> Signup and view all the answers

    What are the ECG morphologies associated with ST elevation?

    <p>Convex, Coved, Horizontal/Plateau, Oblique, Concave</p> Signup and view all the answers

    A significant ST elevation of ≥2.5mm in leads V1 to V3 indicates myocardial infarction in individuals over ______ years old.

    <p>40</p> Signup and view all the answers

    Match the following causes of ST elevation with their descriptions:

    <p>Prinzmetal angina = Transient ST elevation Hyperkalemia = Electrolyte imbalance causing elevation LBBB = Bundle branch block leading to ST changes Normal variant = Benign early repolarization pattern</p> Signup and view all the answers

    What is a common trigger for symptoms in chronic stable angina?

    <p>Physical exertion or stress</p> Signup and view all the answers

    Chronic stable angina typically lasts more than 30 minutes.

    <p>False</p> Signup and view all the answers

    What type of medication is commonly used to relieve symptoms of chronic stable angina?

    <p>Nitroglycerine</p> Signup and view all the answers

    A positive treadmill test indicates a ST segment deviation of ______ mm.

    <p>2</p> Signup and view all the answers

    Match the following conditions with their corresponding categories:

    <p>Chronic stable angina = Indicated for exercise stress test Rest symptoms = Contraindication for exercise stress test Aortic stenosis = Contraindication for exercise stress test Asymptomatic with risk factors = Indicated for exercise stress test</p> Signup and view all the answers

    Which of the following is indicative of pericarditis?

    <p>PR segment depression</p> Signup and view all the answers

    Benign early repolarization is characterized by global ST elevation and PR segment depression.

    <p>False</p> Signup and view all the answers

    What is another name for Takotsubo cardiomyopathy?

    <p>Broken heart syndrome</p> Signup and view all the answers

    The presence of an Osborne wave is associated with ______.

    <p>hypothermia</p> Signup and view all the answers

    Match the following ECG features with their corresponding conditions:

    <p>Global ST elevation = Pericarditis Notching of J point = Benign early repolarization Osborne wave = Hypothermia Catecholamine induced cardiac failure = Takotsubo Cardiomyopathy</p> Signup and view all the answers

    Which of the following is a correct indication for myocardial perfusion scintigraphy (MPS)?

    <p>Patients with resting symptoms</p> Signup and view all the answers

    Intravascular ultrasound is the gold standard for ejection fraction measurement.

    <p>False</p> Signup and view all the answers

    Which radionuclide is commonly used in myocardial perfusion scintigraphy?

    <p>Tc99 or Thallium</p> Signup and view all the answers

    The primary treatment to decrease heart rate and blood pressure after myocardial infarction is ______.

    <p>β-blockers</p> Signup and view all the answers

    Match the following drugs with their primary action:

    <p>Nitrates = Increase heart rate, decrease blood pressure β-blockers = Decrease heart rate, decrease blood pressure Calcium Channel Blockers = Decrease heart rate Ranolazine = No effect on blood pressure or heart rate</p> Signup and view all the answers

    Which statements accurately describe Prinzmetal Angina features? (Select all that apply)

    <p>Angiography shows normal results.</p> Signup and view all the answers

    Diastolic current in injury indicates current flow towards ischemia.

    <p>False</p> Signup and view all the answers

    What are the names of the three glycoprotein IIb-IIIa inhibitors used for periprocedural stenting?

    <p>Abciximab, Eptifibatide, Tirofiban</p> Signup and view all the answers

    The Kingmaker segment is also known as the __________.

    <p>ST segment</p> Signup and view all the answers

    Match the current types with their characteristics:

    <p>Systolic current = ST elevation Diastolic current = ST depression Subepicardial injury = Current flows towards injured myocardium Subendocardial ischemia = Current flows away from ischemia</p> Signup and view all the answers

    What does ST depression in an ECG typically indicate?

    <p>Possible ischemia</p> Signup and view all the answers

    De Winter T Waves are considered a normal finding in an ECG.

    <p>False</p> Signup and view all the answers

    What condition does the presence of Left Bundle Branch Block indicate in an ECG?

    <p>It indicates a block in the electrical conduction system, affecting how electrical impulses travel through the heart.</p> Signup and view all the answers

    Horizontal ST Depression is associated with __________.

    <p>ischemia</p> Signup and view all the answers

    Match the ECG findings with their implications:

    <p>Left Ventricular Hypertrophy = Increased heart muscle mass Acute antero-septal infarction = Heart attack in the front septal wall Pseudoinfarction = Pattern mimicking a heart attack Brugada syndrome = Heart rhythm problem</p> Signup and view all the answers

    Which of the following is a potential diagnosis associated with ECG findings?

    <p>Brugada syndrome</p> Signup and view all the answers

    Evolving to MI implies a progression towards a myocardial infarction.

    <p>True</p> Signup and view all the answers

    What is the significance of 'scoop' in an ECG analysis?

    <p>It may indicate the presence of digoxin, a medication often used for heart conditions.</p> Signup and view all the answers

    Study Notes

    Coronary Circulation

    • Right coronary circulation supplies the inferior, posterior, and right ventricular walls of the heart.
    • Left coronary circulation supplies the anterior, septal, and lateral walls of the heart.

    Surfaces of the Heart

    • Anterior sternocostal surface is primarily composed of the right ventricle.
    • Inferior diaphragmatic surface is comprised of both the right and left ventricles.
    • Posterior surface is primarily the left atrium.

    Coronary Dominance

    • Dominance is determined by the artery supplying the posterior interventricular sulcus (posterior descending artery).
    • Right dominant: 85% of the population.
    • Left dominant: 15% of the population.

    Right Coronary Artery

    • Origin: Right AV sulcus.
    • Branches: SA nodal branch, atrial branches, acute marginal artery, branch to AV node, terminal branches.
    • Proximal RCA occlusion: Can cause sinus bradycardia, atrial arrhythmias, and right ventricular MI.
    • Distal RCA occlusion: Can cause right ventricular MI depending on the relationship to the acute marginal artery.

    Left Coronary Artery

    • Origin: Left AV sulcus
    • Branches: Left anterior descending artery (LAD)...

    Acute Coronary Syndrome (ACS)

    • ACS is a spectrum of conditions involving a sudden blockage of coronary arteries, including unstable angina, non-ST-elevation MI, and ST-elevation MI.

    Hibernation vs. Stunning of Myocardium

    • Hibernation: Chronic ischemia, persistent ischemic dysfunction, diagnosable via FDG-PET or MRI.
    • Stunning: Acute ischemia, transient post-reperfusion segmental dysfunction.

    Management of ACS - Pharmacological Intervention

    • First-line drugs:
      • Nitrates: Increase heart rate and lower blood pressure; Tolerance can be a limitation.
      • Beta-blockers: Decrease heart rate and lower blood pressure, prolong life post MI.
      • Calcium channel blockers: Decrease heart rate and lower blood pressure.

    Stenting

    • Drug-eluting stents: Coating of drugs (tacrolimus/paclitaxel) for prolonged drug release.
    • Bare metal stents: Not as effective as drug eluting stents.

    Prinzmetal Angina

    • Characterised by rest angina rapidly relieved by nitrates.
    • Transient ST elevation.
    • Normal coronary angiography.
    • Beta-blockers are avoided in this condition due to vasospastic angina.

    Kingmaker Segment

    • Also known as the ST segment.
    • Starts at the end of the J point and ends at the onset of the T wave.

    ECG Analysis

    • ECG waveform descriptions: RR interval, P wave duration, PR segment, QRS duration, ST segment duration, QT interval, U interval.
    • Waveform types: Non-concave (convex shaped), Concave (saddle shaped).

    ST Elevation MI (STEMI)

    • ECG morphologies: Convex, Coved, Horizontal/Plateau, Oblique, Concave.
    • Sequence of changes in STEMI:
      • Hyperacute T wave
      • Hyperacute T waves with ST Elevation
      • Development of pathologic Q waves, decreased amplitude of the R waves, and further ST and T wave changes

    Other Causes of ST Elevation

    • Prinzmetal angina
    • Hyperkalemia
    • Left Bundle Branch Block

    Normal Variant/Benign Early Repolarization

    • Can be mistaken for ST elevation.
    • Often seen in patients with left ventricular aneurysm.

    ECG Interpretations

    • Left Ventricular Hypertrophy: Indicated by ECG findings.
    • Left Bundle Branch Block: Another finding from the ECG.
    • ST Depression: Showing possible ischemia, various types of ST depression are noted, with probable ischemia being the primary interpretation.
    • De Winter T Waves: Identified as a type of T wave abnormality.
    • Evolves to MI: Implies progression towards a myocardial infarction (heart attack).

    Other ECG Findings

    • Pericarditis
    • Pseudoinfarction
    • Acute Antero-Septal Infarction
    • Brugada Syndrome
    • Horizontal ST Depression
    • Sloping ST
    • Scoop

    Myocardial Perfusion Scintigraphy (MPS)

    • Done with Tc99m or Thallium.
    • Useful in patients with resting symptoms or abnormal baseline ECG.
    • Helps differentiate between ischemia and infarction, localize ischemia, assess revascularization completeness.

    Miscellaneous Points

    • FDG PET: Distinguishes between stunned and scarred myocardium.
    • Electron beam CT: Quantifies cardiac calcification.
    • MRI: IOC for myocardial fibrosis/ejection fraction, gold standard for ejection fraction.
    • Intravascular USG: IOC for ostial left main lesion/coronary dissection.

    Investigations

    • Exercise stress test/Treadmill test:
      • Indications: Chronic stable angina, asymptomatic patients with risk factors.
      • Contraindications: Rest symptoms, aortic stenosis, hypertrophic cardiomyopathy (HOCM).

    Bruce Protocol

    • Positive treadmill test: Indicates 2 mm horizontal or down sloping ST segment depression.

    Benign Early Repolarization

    • ST elevation
    • Notching of J point (hook effect).
    • Differential diagnosis: Pericarditis.
    • No PR segment depression.

    Pericarditis

    • Clinical Features: History of acute illness
    • Global ST elevation.
    • Concave upward ST segment.
    • PR segment depression.
    • No reciprocal changes.

    Post-DC Cardioversion

    • Related to electrical shock therapy.

    Hypothermia

    • Characterized by Osborne wave.

    Takotsubo Cardiomyopathy

    • AKA Broken heart syndrome.
    • Catecholamine induced cardiac failure.
    • Most common in middle-aged females.

    Chronic Stable Angina

    • Presentation: Middle-aged to elderly patient with risk factors.
    • Symptoms: Chest tightness/squeezing/burning.
    • Location: Behind/left of mediastinum.
    • Radiation: Any dermatome from C4 - T.
    • Duration: 30 minutes suggest ACS.
    • Treatment: Excellent response to sublingual or oral NTG.

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    Description

    This quiz covers essential aspects of coronary circulation, including the right and left coronary arteries and their supply areas. It also explores the surfaces of the heart and the concept of coronary dominance in the population. Test your knowledge on these critical cardiovascular topics.

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