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EKG Assignment
 Provide a short answer in the box below for each question.
You are the ACNP in the ER. 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 1hour 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 also is diaphoretic and anxious. You review his 12 lead EKG, as per below.
Where is the location of the patient’s infarction? What coronary artery is the likely cause?

Answer: Posterior wall, true posterior wall myocardial infarction (Thygesen et al, 2012)
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 happens to mention that she has suffered 9hours of chest pain and sweating, which takes you by surprise. Your patient further describes the pain as both gnawing and intermittent. She thought she was experiencing heartburn, but admits that she has never experienced heartburn before, so she is not sure. You perform a 12-lead EKG immediately and call 911.
Where is the location of the MI? What significant EKG findings support that diagnosis?
Answer: Anterior MI, taller than normal R-waves in leads V3 and V4 along with the characteristic ST-segment elevation.

Interpret the EKG recording below. What is the finding, including location? Is this acute or chronic? Explain.

Answer; Acute ST –segment elevated MI (STEMI) on the inferior/posterior right ventricular wall.

This is because of the reciprocal orientations in the anterior leads.

A 27-year-old African-American female is admitted to the hospital with severe sepsis related to a cellulitis infection in the groin. The patient was treated appropriately with antibiotics, and then transferred out of the intensive care unit to the medical/surgical unit.
On post-admission Day 4, she complains of feeling anxious, short of breath, and chest pain that is worse with deep inspiration. The resident provider on call orders a 12-lead EKG and asks you to interpret it for her, as she has to run a code that is occurring simultaneously.
You assess the patient, then review the 12-lead EKG. What is your interpretation?

Answer: possibly left bundle branch block because V5 and V6 have positive QRS while it is reverse in V1 and V2
Your 52-year-old Asian female patient with a past medical history of smoking and maybe “some sort of bronchitis” presents to your cardiology clinic. She states she has been having palpitations, light-headedness, and a feeling as if her heart is beating irregularly. The symptoms are not constant and currently she is not having any symptoms. You obtain a 12-lead EKG in the clinic.
What is your interpretation of her 12 Lead EKG, as per below?

Presence of P-pulmonale 9 featured by tall peaked T p-waves in lead II, III, and aVF
A 77-year-old female with a history of dyslipidemia, hyperthyroidism, and colon cancer presents to the emergency room with chest pain that radiates to her left arm. She is also nauseous. Her symptoms occurred after she left a nearby casino, where she had spent several hours. You attend to her in the ER and order a 12-lead EKG, stat.
You review the EKG and conclude that she has sustained a posterior wall myocardial infarction. A posterior wall myocardial infarction is best revealed in which leads?
Tall R waves and ST-segment depression in leads V1-V4
What findings would you expect to see in the leads that visualize an acute posterior wall myocardial infarction on your patient’s 12-lead EKG?
ST segments horizontally depressed
Tall and broad R waves which are dominant (R/S >1) in V2.

An 87-year-old female with long standing uncontrolled HTN presents to the emergency room after experiencing symptoms and signs of a stroke. You order an EKG as part of the standard procedures. What is your impression of the 12-lead EKG below:

ST-segment depression and left ventricular hypertrophy, with tall and upright T waves
You are the hospitalist ACNP on call and you complete a follow-up assessment on a 72-year-old female who was admitted for syncope yesterday. You hear a loud first heart sound and mid-diastolic murmur, which was not documented in the admission note from yesterday by the attending provider at that time. You order an EKG. Your interpretation of the results on the 12-lead EKG below is:

Non-sinus rhythm, paroxysmal dysrhythmia, and left ventricular hypertrophy

Using the EKG profile below, interpret the EKG and identify the AXIS:

QRS complex negative in lead 1 and positive in a VF.
Indicating a right axis deviation
References
Thygesen, K.; Alpert, J. S.; Jaffe, A. S.; Simoons, M. L.; Chaitman, B. R.; White, H. D. (2012). “Third Universal Definition of Myocardial Infarction”. Circulation. 126 (16), 2020–2035