Ischemia, MI Stages, and ECG Changes Quiz

Symptoms and Premature Ventricular Contraction (PVC)

• Lightheadedness, dizziness, and syncope are symptoms of PVC
• PVC requires closer evaluation and can be common in adults due to caffeine or pulmonary disease
• Wide bizarre complexes can be dangerous and lead to lethal arrhythmia

PVC's and Exercise

• PVC's decrease with exercise, which is a desired response, as higher heart rate suppresses PVC's
• PVC's increase with exercise, which is a less desirable response, and may be ischemic in origin
• No change in PVC's with exercise indicates that they are not exercise-related

Ischemia

• Ischemia occurs when oxygen demand exceeds supply
• It is brought on by exercise and relieved with rest or nitroglycerine
• Changes in ST segment on EKG indicate ischemia, such as 1 mm depression or 2 mm depression if baseline is already depressed

Angina

• Angina is a crushing sensation, but can also present as pain in jaw, arm, neck, or GI disturbances
• It can be confused with musculoskeletal pain
• If a patient develops angina, terminate exercise, decrease workload, and notify MD

Angina Levels

• Level I: initial perception of discomfort
• Level II: minimal discomfort worsens or extends to another area
• Level III: pain becomes more intense and patient must stop activity
• Level IV: severe pain, same as during a heart attack

Congestive Heart Failure (CHF)

• Can have chronic CHF at rest or develop with exercise
• Development of S3 heart sound, crackles in lungs, drop in SBP, rise in HR, and SOB indicate CHF

Reasons to Discontinue Exercise

• 3 or more consecutive PVC's
• New onset multifocal PVC's
• New onset A-fib or flutter
• New onset supraventricular tachycardia (SVT)
• New onset heart block
• Chest discomfort
• New onset dyspnea at lower workload than usual
• Drop in BP with exercise
• Dizziness
• New musculoskeletal discomfort
• New orthopedic or neurologic condition

Cardiac Rehabilitation

• A multidisciplinary program for patients with heart disease to reach maximal functional potential
• Includes education, psychosocial support, and exercise

Ischemia and MI

• Ischemia requires 12-lead ECG and shows T-wave inversion and ST segment depression
• Changes associated with MI include trans-mural and sub-endocardial MI, acute ST elevation, and hyper-acute T waves

STEMI and NSTEMI

• STEMI: trans-mural MI, acute ST elevation, and hyper-acute T waves
• NSTEMI: sub-endocardial MI, ST segment depression, and T-wave inversion

Cardiac Tamponade

• Compression of the heart due to accumulation of fluid in the pericardial sac
• Prevents ventricle from filling and contracting properly
• Medical emergency and can be a complication of surgery or occur spontaneously

Phase I, II, and III Cardiac Rehabilitation

• Phase I: early post-op, 1-2 days, focus on preventing pulmonary complications
• Phase II: outpatient, 30-60 min, 3 days/week, for patients with arrhythmias, angina, or other medical issues
• Phase III: location-based, 6-12 months, recommend regular medical check-ups

Conduction Disturbances

• Disruptive of normal rate or rhythm, can be symptomatic (syncope, dizziness, angina, dyspnea, palpitations) or lethal (sudden cardiac death)
• Treatment: medical, pacemaker, or AICD (Automatic Implantable Cardioverter Defibrillator)

Test your knowledge on ischemia, myocardial infarction stages (STEMI, NSTEMI), and ECG changes associated with different stages of MI. This quiz covers topics such as T wave inversion, ST segment depression, hyper-acute T waves, and more.