Ischemic Disorders Review

Headshot of Chris Anderson, MD · Clinical Education Director, Pediatrics
Chris Anderson
MD · Clinical Education Director, Pediatrics
envelope icon
Headshot of Kevin Hodges, Vice Chair, Emergency Medicine
Kevin Hodges
Vice Chair, Emergency Medicine
envelope icon phone icon
Table of Contents

Introduction to review.

  1. Complete basic measurements.
  2. Do all previous work.
  3. Note if inverted T waves or ST segment depression is present in two or more leads that represent a pattern in Table 13.2. Here the ST segments are diffusely abnormal.
  4. Provide an interpretation.

 

 

Clinically-Based Critical Thinking: Interpretation

ST segment depression is consistent with ischemia or infarction. On a single EKG, the First Rule of the T Wave applies. The ST depression may represent infarction, which may be new or old. It may also represent ischemia. More information is needed. Is the patient symptomatic? Is there an old EKG available? If so, are these ST changes new?

Worksheet V.1

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.

Worksheet V.2

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies.
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.

Worksheet V.2

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies.
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.

Worksheet V.3

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies.
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.

Worksheet V.4

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies.
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.

Worksheet V.5

Complete the basic measurements, evaluation, and interpretation for the EKG below.

Parameter Measurement Interpretation
HR 79  
Rhythm Sinus rhythm  
PR 0.16 to 0.18  
QRS 0.08 Normal
QT 0.40  
QTc 0.460 High
P direction    
QRS direction    
Abnormal parameter If present, note the leads or location
Inverted T waves The T waves are abnormal and point away from the septum (V1 and V2), and anterior (V3) walls. Since this is the only EKG, the First Rule of the T Wave applies.
ST depression
ST elevation
Q waves or equivalents

Clinically-Based Critical Thinking: Interpretation

There is ischemic heart disease, but it maybe ischemia or infarction, and new or old. Clinically there may be an old NSTEMI, a new NSTEMI, or unstable angina. More information is needed.