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Study guide for nmtt 2167, Study Guides, Projects, Research of Biology

Dakota State University (DSU)Biology

Long study guide for nmtt 2167

Typology: Study Guides, Projects, Research

2023/2024

Uploaded on 11/08/2024

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NMTT 2167 Practicum III – Final Examination (Take-away Notes)
1. In a standard 12-lead electrocardiogram (ECG or EKG) setup, a total of 10 lead wires are used.
The 12-lead ECG consists of the following leads:
3 Limb Leads:
Lead I
Lead II
Lead III
3 Augmented Limb Leads:
aVR
aVL
aVF
6 Precordial (Chest) Leads:
V1
V2
V3
V4
V5
V6
Each of these 12 leads requires a single electrode lead wire, for a total of 12 lead wires.
However, since the limb leads (I, II, III) are derived from the 4 limb electrodes, only 4 limb electrode lead
wires are required.
Therefore, the total number of lead wires in a standard 12-lead ECG setup is 10 - the 4 limb leads plus the
6 precordial leads.
2. In a standard 12-lead electrocardiogram (ECG) setup, the ventricular lead that is placed on the mid-
clavicular line in the 5th intercostal space is the V5 lead.
The standard placement of the 12 ECG leads is as follows:
V1: 4th intercostal space, right sternal border
V2: 4th intercostal space, left sternal border
V3: Midway between V2 and V4
V4: 5th intercostal space, mid-clavicular line
V5: 5th intercostal space, left mid-clavicular line
V6: 5th intercostal space, left anterior axillary line
So the V5 lead is placed on the mid-clavicular line in the 5th intercostal space, which provides a lateral
view of the left ventricle.
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NMTT 2167 Practicum III – Final Examination (Take-away Notes)

  1. In a standard 12-lead electrocardiogram (ECG or EKG) setup, a total of 10 lead wires are used. The 12-lead ECG consists of the following leads: 3 Limb Leads: Lead I Lead II Lead III 3 Augmented Limb Leads: aVR aVL aVF 6 Precordial (Chest) Leads: V V V V V V Each of these 12 leads requires a single electrode lead wire, for a total of 12 lead wires. However, since the limb leads (I, II, III) are derived from the 4 limb electrodes, only 4 limb electrode lead wires are required. Therefore, the total number of lead wires in a standard 12-lead ECG setup is 10 - the 4 limb leads plus the 6 precordial leads.
  2. In a standard 12-lead electrocardiogram (ECG) setup, the ventricular lead that is placed on the mid- clavicular line in the 5th intercostal space is the V5 lead. The standard placement of the 12 ECG leads is as follows: V1: 4th intercostal space, right sternal border V2: 4th intercostal space, left sternal border V3: Midway between V2 and V V4: 5th intercostal space, mid-clavicular line V5: 5th intercostal space, left mid-clavicular line V6: 5th intercostal space, left anterior axillary line So the V5 lead is placed on the mid-clavicular line in the 5th intercostal space, which provides a lateral view of the left ventricle.
  1. The starting infusion rate for dobutamine can vary depending on the clinical situation and the patient's individual response, but some general guidelines are: For stress echocardiography: The starting dose is usually 5-10 mcg/kg/min. The infusion rate can be titrated upward in 5-10 mcg/kg/min increments every 3-5 minutes to achieve the target heart rate (usually 85% of the age-predicted maximum heart rate). The maximum dose for stress echocardiography is typically 40 mcg/kg/min.
  2. The maximum recommended dosage of persantine (dipyridamole) for cardiac patients is as follows: For Stress Testing: The standard dosage for stress testing is 0.56 mg/kg (0.8 mg/kg if using dipyridamole without thallium imaging) administered intravenously over 4 minutes. The maximum single dose should not exceed 0.8 mg/kg or 60 mg, whichever is lower.
  3. There are several key reasons to stop a treadmill stress test, including: Target Heart Rate Achieved: The test should be stopped when the patient reaches their target heart rate, which is typically 85% of their age-predicted maximum heart rate. Significant ECG Changes: The test should be stopped if there are significant ST-segment changes, arrhythmias, or other concerning electrocardiographic (ECG) findings. Patient Requests to Stop: The test should be stopped if the patient requests to stop due to fatigue, discomfort, or any other reason. Maximum Predicted Heart Rate Reached: The test should be stopped if the patient reaches their maximum predicted heart rate, which is typically 220 minus the patient's age.
  4. For a pharmacologic stress cardiac exam, such as a nuclear stress test using a vasodilator like adenosine or regadenoson, the nuclear medicine technologist should monitor the patient's vital signs at the following intervals: Before the pharmacologic stress agent is administered: The technologist should obtain and record the patient's baseline vital signs, including blood pressure, heart rate, and respiratory rate. Every 1-2 minutes during the stress phase: After the completion of the stress agent administration, the technologist should continue to monitor the patient's vital signs every 1-2 minutes during the stress phase, which usually lasts 3-5 minutes. At the end of the stress phase: The technologist should obtain and record the patient's vital signs immediately after the completion of the stress phase.

Similar to adenosine, the use of dipyridamole in patients with severe or uncontrolled hypertension may result in undesirable hypotensive episodes. In contrast, the preferred pharmacologic stress agent for patients with hypertension is typically regadenoson (Lexiscan): Regadenoson is a selective A2A adenosine receptor agonist that has a more favorable hemodynamic profile, with less pronounced effects on blood pressure and heart rate compared to other stress agents. Studies have shown that regadenoson can be used safely in patients with hypertension, with a lower incidence of significant hypotension or other adverse cardiovascular events.

  1. Atrial fibrillation is more common in the elderly, due to rheumatic mitral valve disease. This statement is incorrect. Rheumatic mitral valve disease is not the primary reason why atrial fibrillation is more common in the elderly population. The main reasons for the increased prevalence of atrial fibrillation in the elderly are: Structural and electrical remodeling of the atria: With aging, the atrial myocardium undergoes various structural changes, such as atrial dilatation, fibrosis, and loss of atrial myocytes.These structural changes can lead to electrical heterogeneity and conduction disturbances within the atria, creating a substrate that is more prone to the development of atrial fibrillation. Autonomic nervous system changes: Aging is associated with alterations in the balance of the autonomic nervous system, with a relative increase in sympathetic tone and a decrease in parasympathetic tone. This autonomic imbalance can contribute to the initiation and maintenance of atrial fibrillation. Comorbidities: The elderly population often has a higher prevalence of conditions that increase the risk of atrial fibrillation, such as: Hypertension, Coronary artery disease, Heart failure, Valvular heart disease (not specifically rheumatic mitral valve disease), and Thyroid disorders. Inflammation and oxidative stress: Aging is associated with increased systemic inflammation and oxidative stress, which can contribute to atrial remodeling and the development of atrial fibrillation. Genetic and environmental factors: Genetic predisposition and environmental factors, such as lifestyle, diet, and physical activity, can also play a role in the increased incidence of atrial fibrillation in the elderly population.