These CCRN practice questions target diagnostics — including LBBB, Left Bundle Branch Block, Sgarbossa Criteria. The complete CCRN deck holds 1000 flashcards, 40 of them dedicated to this topic. Study the free samples below, then unlock the whole collection for a one-time $7.
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A patient presents with ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded, and what additional assessment is prioritized?
Show answer →Occlusion: Right Coronary Artery (RCA) causing an Inferior MI. Priority: Obtain a right-sided ECG (V4R) to assess for Right Ventricular Infarction (RVI). Clinical Pearl: Up to 40% of inferior MIs involve the RV. In RVI, avoid preload reducers like nitroglycerin and morphine, as these patients are highly preload-dependent; treatment focus is aggressive IV fluid resuscitation. Exam Strategy: AACN emphasizes recognizing that inferior MIs often present with bradycardia or heart blocks due to RCA supplying the SA/AV nodes.
A 12-lead ECG reveals ST-segment depression and tall, upright R-waves in leads V1-V3. What is the most likely diagnosis, and how should it be confirmed?
Show answer →Diagnosis: Posterior Wall Myocardial Infarction. This is a STEMI-equivalent. Confirmed by: Placing posterior leads V7, V8, and V9 (elevation ≥ 0.5 mm is diagnostic). Clinical Reasoning: The changes in V1-V3 are reciprocal to the posterior wall. Exam Strategy: Don't be fooled by ST depression in V1-V3; in the context of acute chest pain, this is rarely just ischemia—it is often an injury pattern of the posterior wall (supplied by the RCA or LCx).
In a patient with a known Left Bundle Branch Block (LBBB), which ECG finding is most specific for an acute MI according to the Sgarbossa Criteria?
Show answer →ST-segment elevation ≥ 1 mm that is concordant with (in the same direction as) the QRS complex. Rationale: In LBBB, the ST segment should normally be discordant (opposite) to the QRS. Concordant elevation is highly specific for MI. Other criteria: ST depression ≥ 1 mm in V1-V3 or excessive discordance (ST elevation ≥ 5 mm or >25% of the S-wave). Exam Tip: AACN focuses on the shift from new LBBB = STEMI to using specific criteria like Sgarbossa or Smith-modified Sgarbossa.
A patient's ECG shows deep, symmetric T-wave inversions in leads V2 and V3 while the patient is currently pain-free. What syndrome does this suggest, and what is the clinical significance?
Show answer →Wellens' Syndrome (Type B). Clinical Significance: This pattern indicates critical proximal Left Anterior Descending (LAD) artery stenosis. Even if the patient is asymptomatic now, they are at high risk for a massive anterior wall MI (widow maker). Exam Strategy: AACN tests the recognition that T-wave changes in precordial leads without Q-waves in a pain-free patient often signify impending disaster; avoid stress testing as it may induce a lethal MI.
Which ECG leads localize an injury to the high lateral wall of the left ventricle, and which artery is typically involved?
Show answer →Leads: I and aVL. Artery: Left Circumflex (LCx) or a diagonal branch of the LAD. Clinical Pearl: High lateral MI often presents with reciprocal ST depression in the inferior leads (II, III, aVF). Exam Strategy: Differentiate this from the low lateral wall (V5, V6). If elevation is seen in I, aVL, V5, and V6, it is a comprehensive lateral wall MI.
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Try 30 free CCRN cards firstThe full CCRN deck contains 1000 flashcards, and 40 of them focus on diagnostics. This page shows 5 free samples.
Our CCRN deck dedicates 40 of 1000 cards (4%) to diagnostics — always cross-check the official AACN exam outline for the current blueprint weighting.
Yes — the samples on this page are free, and the CCRN preview page has 30 more free cards. Full access to all 1000 cards is a one-time $7.
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