Cardiac Flashcards
A 57-year-old man complains of weakness and lightheadedness after working in his gard on a hot day for several hours. He admits to consuming several alcoholic beverages. His cardiac rythm is shown. His BP is 116/56 mm Hg, pulse is rapid and weak, and respirations are 18 breaths/min. He tells you that he has an irregular heartbeat. What should you do?
Give a 250- to 500-mL fluid bolus
The cardiac rhythm in lead II is regular at a rate of 90/min. The QRS complexes measure 0.16 second an inverted P waves precede each WRS at a 1:1 ratio. Which of the following rhythms does this describe?
Accelerated junctional rhythm with ventricular abberancy
What is the therapeutic effect of aspirin when administered to a patient experiencing an acute coronary syndrome (ACS)?
Decreased thromboxane A2 production, which inhibits platelet aggregation
A 68-year-old woman presents with shortness of breath that started 2 days ago. Her BP is 78/54 mm Hg, pulse is 124 beats/min an weak, respirations are 26 breaths/min and labored, and oxygen saturation is 78%. The cardiac monitor reveals sinus tachycardia with occasional PVCs and asucultation of her lungs reveals diffuse coarse crackles. Which of the following is indicated for her?
Dopamine
Which of the following is the correct dose and concentration of epinephrine for an adult in nontraumatic cardiac arrest?
10 mL epinephrine 0.1 mg/mL
Which of the following is the MOST common cause of sudden cardiac arrest in adults?
Cardiac dysrhythmia
Which of the following is the correct adult dosing regimen for adenosine?
6 mg, followed by 12 mg in 2 minutes if needed
What is the main purpose of ascultating heart tones?
Determine if the cardiac valves are functioning properly
A 60-year-old patient has a BP of 240/120 mm Hg. Which of the following additional assessment findings is clinically significant?
Slurred speech
Following your initial 2 minutes of CPR, you observe the cardiac rhythm shown. What should you do?
Continue CPR and assess another lead
A 47-year-old man took two of his prescribed nitoglycerin tablets prior to calling EMS. He tells you that he has a throbbing headache and is still experiencing chest pain. What should you suspect?
He is expeiencing continued myocardial ischemia.
Which of the following is a correct drug and dose to give to a patient with refractory ventricular fibrillation?
Lidocaine, 1 mg/kg
An 80-year-old man with a history of emphysema presents with lower extremity swelling and a swollen abdomen. HIs BP is 104/60 mm Hg, pulse is 100 beats/min, and respirations are 18 breaths/min. What should you suspect?
Cor pulmonale
According to current treatment guidelines, which of the following is an indication to perform chest compressions on a patient who has a left ventricular assist device?
The patient’s end-tidal CO2 is less than 20 mm Hg.
A man describes his chest pain with a clenched fist. What is this sign called and what does it convey?
Levine; pressure
When obtaining a 12-lead ECG, where should you position lead V1?
In the fourth interscostal space on the right sternal border
What is meant by the term paroxysmal supraventricular tachycardia?
It begins and ends abruptly
What causes Prinzmetal angina?
Coronary artery vasospasm
Which of the following would likley occur when a person’s mean arterial pressure exceeds 150 mm Hg?
Increased intracranial pressure
What occurs at the beginning of ventricular contraction?
The atrioventricular valves close and the semilunar valves are forced open.
Using the ECG shown, in which quadrant is the cardiac axis in the frontal plane?
Left
Which of the following is a side effect of atropine sulfate?
Acute urinary retention
A 56-year-old man had chest pressure for the past 2 days, but refused to go to the hospital. His wife called EMS today when she noticed that he was confused. His skin is pale and diaphoretic, his pulse is rapid and weak, and his BP is 80/40 mm Hg. What should you suspect?
Cardiogenic shock
Physiologically, what occurs during the upstroke phase of chest compressions?
Blood is pullsed back to the heart
Epinephrine is given during cardiac arrest because of which of the following effects?
Vasoconstriction, which improves coronary and cerebral prefusion
A woman’s initial cardiac arrest rhythm is asystole. After 2 minutes of CPR, the cardiac monitor reveals coarse ventricular fibrillation. What should you do?
Defibrillate and immediately resume CPR
Which of the following findings is consistent with an acute ischemic stroke involving the left cerebral hemisphere?
Aphasia, right side weakness, and facial droop
A 55-year-old man is confused and diaphoretic. His BP is 98/58 mm Hg, his pulse is rapid and weak, and his respirations are 22 breaths/min. His cardiac is rhythm is shown. What should you do?
Give 2.5 mg midazolam and cardiovert
Which of the following ECG lead configurations is correct?
To assess lead II, place the negative lead on the right arm and the positive lead on the left leg.
The cardiac rhythm is irregular and the rate is 50/min. There are more P waves than QRS complexes, and the PR intervals vary in duration. How should you interpret the rhythm described?
Second-degree AV block
Which of the following questions should you ask a patient who is complaining of chest pain?
Can you describe the quality of the pain?
After 5 minutes of resuscitation, you achieve return of spontaneous circulation in a 44-year-old man. He is moving his arms and occasionally opens his eyes. His BP is 106/62 mm Hg. pulse is 110 beats/min, respirations are 6 breaths/min, and oxygen saturation is 99%. What should you do?
Ventilate at 10 breaths/min with room air and obtain a 12-lead-ECG
You and your team are attempting to resuscitate a 66-year-old man in cardiac arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient is intubated and vascular access has been established. What should you do next?
Administer 10 mL epinephrine 0.1 mg/mL
Which of the following could occur as a result of a right coronary artery occlusion?
AV Heart Block
Following return of spontaneous circulation, a 60-year-old man who was in ventricular fibrillation remains unresponsive. His BP is 88/58 mm Hg, pulse is 100 beats/min, and respirations are 6/min and irregular. What should you do?
Ventilate at 10 breaths/min and give a 250- to 500-mL fluid bolus
You are assessing a woman who complains of chest discomfort. She is conscious, alert, and oriented. Her skin is diaphoretic. Her BP is 122/72 mm Hg, her pulse rate is 124 beats/min, and her respirations are 20 breaths/min. Considering her chief complaint, which of your assessment findings is the MOST clinically significant?
Pulse rate
Which of the following occurs during phase 1 of the cardiac action potential?
Inward sodium channels close and the cell begins to repolarize
In which of the following situations should epinephrine be administered as soon as possible?
Asystole without evidence of trauma
The 12-lead ECG shown is of a 52-year-old woman who is having chest pain. How should you interpret the ECG?
Left bundle branch block
Which of the following findings is observed with a right bundle branch block
Terminal R wave in lead V1
Which of the following statements regarding right ventricular failure is correct?
Sacral and pedal edema are common signs of RVF
Where is the point of maximal impulse located in most people?
Left anterior chest, in the midclavicular line, at the fifth intercostal space
A 30-year-old man presents with nausea and generalized weakness. His BP is 146/88 mm Hg, pulse is slow and regular, and respirations are 14 breaths/min. His cardiac rhythm is shown. What should you do?
Give 4 mg ondansetron
The 12-lead ECG shows a regular rhythm at 80/min. P waves are visible in lead II. The QRS duration is 128 ms; QS waves are present in leads V1 and V2; and monophasic R waves are observed in leads I, aVL, and V6. There is approximately 2 mm of ST elevation in leads V1-V3. Which of the following does this describe?
Left bundle branch block
A 60-year-old woman complains of chest pressure and nausea. The 12-lead ECG shows 3 mm of ST elevation in leads V1-V4 and occasional PVCs. Her BP is 144/88 mm Hg, pulse is 100 beats/min and strong, respirations are 16 breaths/min, and oxygen saturation is 95%. What treatment is indicated for her?
324 mg aspirin PO, 0.5 to 1 mcg/kg fentanyl, and 4 mg ondansetron IM or IV push
A 47-year-old woman presents with generalized weakness and near syncope. She has not taken her prescribed beta blocker medication in 3 days. Her cardiac rhythm is shown, and her 12-lead ECG reveals the same. Her BP is 172/90 mm Hg, pulse is rapid and strong, and respirations are 20 breaths/min. What should you do?
Give 0.25 mg/kg diltiazem
A 48-year-old woman presents with acute chest pressure. Her cardiac rhythm is shown. She is conscious and alert, is pale and diaphoretic, and is breathing without difficulty. What should you do?
Give 324 mg asprin PO, obtain a 12-lead ECG, and assess her vital signs
Following three shocks, one doe of epinephrine, and minimally interrupted CPR, a 77-year-old man remains in the cardiac rhythm shown. What should you do?
Give 300 mg amiodarone
Which of the following electrolytes moves slowly into the cardiac cell and maintains the depolarized state of the cell membrane?
Calcium
A 33-year-old woman presents with a narrow-complex tachycardia at a rate of 210/min. She is conscious and alert and complains of tingling in her chest. Her BP is 144/76 mm Hg, pulse is rapid and strong, and respirations are 16 breaths/min. What should you do?
Obtain a 12-lead ECG
A 64-year-old woman complains of pain to her right leg. Assessment of the limb reveals that it is red, swollen, and painful. When she lifts her foot, she experiences severe pain in her calf. What should you suspect?
Deep vein thrombosis
Cardioversion involves delivering a shock that is synchronized to occur during the
R wave
Which of the following findings indicates right ventricular failure?
Engorged jugular veins
A man is suddenly awakened in the middle of the night, gasping for air. He is extremely restless and pale, and is coughing up blood. What should you suspect?
Left-side heart failure
A 77-year-old man present with nausea, vomiting, and blurred vision. He has heart failure and artial fibrillation. He takes lisinopril, digoxin, furosemide, and dabigatran. The cardiac monitor reveals artrial fibrillation with a rate of 50/min. Which of his medications would likley cause his clinical presentation?
Digoxin
When treating a patient with ventricular fibrillation, what should occur while the defibrillator is charging?
Chest compressions
Which of the following are ECG indicators of Wolff-Parkinson-White syndrome?
Delta waves, short PR intervals, and QRS widening
Which of the following is a common pain description in a patient with acute cardiac ischemia?
Pressure
A 70-year-old woman suddenly awakened from sleep with labored breathing. She is anxious and has dried blood on her lips. Her cardiac rhythm is shown. What underlying problem is likley causing her symptoms?
Decreased stroke volume with left heart failure
A 78-year-old female experienced a syncopal episode. She is now conscious, but complains of dizziness and generalized weakness, and her pulse is 150 beats/min and irregular. Which of the following would best explain her syncopal episode?
Acute cardiac dysrhythmia
Despite confirming proper rate, depth, and recoil of chest compressions, you are unable to feel a carotid or femoral pulse during CPR. Which of the following can cause this?
Pericardial Tamponade
A 61-year-old man with the ECG shown complains of nausea. He is conscious and alert with a BP of 118/58 mm Hg, a respiratory rate of 16 breaths/min, and a pulse rate that matches the cardiac monitor. Which of the following is indicated for him?
Ondansetron
What is the correct repeat dose of diltiazem for a 165-pound patient?
26 mg
What are the therapeutic effects of nitroglycerin when administered to a patient with cardiogenic pulmonary edema?
Increased venous capacitance and decreased preload
A 39-year-old woman presents with left lower abdominal pain that began 3 days ago. She is conscious and alert and denies chest pain or shortness of breath. Her BP is 144/84 mm Hg, pulse is 50 beats/min, and respirations are 14 breaths/min. Her cardiac rhythm is shown, and the 12-lead ECG reveals the same. What should you do?
Give 0.5 mcg/kg fentanyl
A 49-year-old man presents with chest pain, severe weakness, and diaphoresis. His cardiac rhythm is shown. His BP is 76/48 mm Hg, pulse is 80 beats/min and thready, and respirations are 18 breaths/min. What should you do?
Begin a norepinephrine infusion at 10 mcg/min
A 65-year-old woman is in cardiac arrest. The ECG shows a regular narrow-complex rhythm at a rate of 105/min. Treatment should include which of the following?
500-mL fluid bolus
A 59-year-old man presents with chest tightness and nausea. His BP is 104/58 mm Hg, pulse is 65 beats/min, respirations are 16 breaths/min, and oxygen saturation is 95%. The 12-lead ECG reveals a sinus rhythm with 3-mm ST elevation in leads II, III, and aVF, and ST despression in leads I and aVL. What should you do?
Obtain a right-side ECG
Which of the following cardiac rhythms is associated with bradycardia, and is characterized by regular RR intervals and a greater ratio of P waves to QRS complexes?
Third-degree AV block
A type II second-degree AV block is characterized by which of the following?
Consistent PR intervals following conducted P waves
In older adults, an S3 heart sound:
signifies moderate heart failure
After performing synchronized cardioversion on a conscious patient with ventricular tachycardia, you see coarse ventricular fibrillation on the monitor. The patient is unresponsive and has agonal gasp. What should you do?
Start CPR and defibrillate
The 12-lead ECG reveals a sinus bradycardia, a prolonged QT interval, and J waves. Which of the following conditions would likley cause these findings?
Hypothermia
On an ECG tracing, which of the following represents the duration of ventricular depolarization and repolarization?
QT interval
Which of the following clinical presentations is consistent with dissection of the ascending aorta?
Acute tearing pain in between the scapulae, blood pressure discrepancy between arms, maximal pain severity from the onset
A 49-year-old man presents with chest pain. The 12-lead ECG shows ST elevation in leads II, III, aVF, and V4R. His BP is 106/58 mm Hg, pulse is 62 beats/min, and respirations are 18 breaths/min. Which of the following medications should be avoided?
Nitroglycerin
A 70-year-old woman presents with fever, chills, and several episodes of vomiting. Her cardiac rhythm is shown. Her BP is 98/60 mm Hg, pulse is rapid and weak, and respirations are 22 breaths/min. What should you do?
Give 500 ml of IV crystalloid
Your patient’s cardiac rhythm is irregularly irregular at a rate of 120 beats/min. The QRS complexes measure 0.10 second in duration, the P wave to QRS ratio is 1:1, and the P waves vary in shape. Which of the following rhythms BEST fits this description?
Multifocal atrial tachycardia
The 12-lead ECG of a 55-year-old man with chest pain is shown. How should you interpret it?
Anterolateral MI
A 70-year-old man in cardiac arrest presents with a wide complex tachycardia on the ECG. His wife tells you that he missed his last three dialysis treatments. She also tells you that he has high blood pressure and hyperthyoidism, and had cardia bypass surgery 3 years ago. What should you suspect?
Hyperkalemia
A 54-year-old man presents with confusion. His radial pulses are absent, his carotid pulse is weak, and he is profusely diaphoretic. In lead II, you observe a wide complex Rhythm at 35/min with dissociated P waves. What should you do?
Begin transcutaneous pacing
A 60-year-old woman is confused, short of breath, and diaphoretic. Her BP is 70/40 mm Hg and her pulse is 38 beats/min and weak. She has no medical history. The ECG shows a slow, wide complex rhythm. What should you do?
Begin transcutaneous pacing
A 39-year-old female presents with acute lightheadedness and palpitations. The ECG reveals a regular tachycardia rhythm at 190/min with QRS complexes that measure 80 ms in duration. Despite vagal maneuvers and adenosine, her cardiac rhythm remains unchanged. She is conscious and alert, has a BP of 118/72 mm Hg, and denies shortness of breath or chest pain. What should you do?
Transport only and monitor her en route
You are assessing a man who has a left ventricular assist device and complains of generalized weakness. He is conscious and alert and tells you that his LVAD is a continous flow device. Which of the following should you use to determine the adequacy of perfusion?
End-tidal CO2
A 34-year-old man complains of a headache. He denies any other symptoms. His BP is 136/88, pulse is 40 beats/min and strong, and respirations are 16 breaths/min. The cardiac monitor reveals sinus bradycardia. What should you do?
Monitor and transport
When administering a sympathomimetic medication, you must be alert for
cardiac dysrhythmias
What would you expect the 12-lead ECG to reveal if a patient was experiencing acute injury involving the interventricular septum and anterior aspect of the left ventricle?
ST segment elevation in leads V1 through V4
Which of the following is a therapeutic effect of aspirin when given to a patient experiencing acute coronary syndrome?
Inhibits platelet aggregation
In a patient with acute coronary syndrome, the presence of dyspnea should make you suspect which of the following?
Pulmonary congestion
By which of the following mechanisms does atropine sulfate exerts its therapeutic effect?
Opposes the vagus nerve
A 73-year-old woman is responsive to pain only after complaining of severe fatigue for the last few days. Her medical history includes two previous heart attacks, renal failure, and hypertension. The ECG shows wide, bizarre QRS complexes at a rate of 45/min and no identifiable P waves. Her BP is 86/46 mm Hg, pulse is thready, and respirations are 20 breaths/min. What should you do?
Give 1 g calcium via slow IV push
At the end of ventricular relaxation, the left ventricle contains 110 mL of blood. What is this referred to as?
Preload
A 56-year-old man started having chest pain while he was lying in bed reading a book. He appears anxious and frightened. His BP is 144/94 mm Hg, pulse is 74 beats/min, and respirations are 18 breaths/min. His medical history includes hypertension and angina. He takes lisinopril and nitroglycerin, but he tells you that he ran out of his nitroglycerin tablets a week ago. Which of the following is the MOST clinically significant of these findings?
He was at rest when the chest pain began
A 57-year-old man presents with acute chest discomfort, shortness of breath, and diaphoresis. His BP is 86/60 mm Hg, and his radial pulses are rapid and weak. His cardiac rhythm is shown. What should you do?
Perform synchronized cardioversion with 50 joules.
Which of the following may you encounter on the 12-lead ECG of a patient who experienced an anterior myocardial infarction 6 months ago?
Q waves in leads V3 and V4
A 50-year-old man is experiencing crushing chest ain and the 12-lead ECG reveals ST elevation in leads V1-V4. His BP is 154/92 mm Hg, pulse is 100 beats/min, respirations are 18 breaths/min, and oxygen saturation is 95%. What should you do?
Give 0.5 to 1 mcg/kg fentanyl
What is the correct initial dose and rate of administration of amiodarone for a patient with refractory ventricular fibrillation?
300 mg via rapid IV or IO push
Which of the following statements regarding sinus tachycardia at a rate of 135 beats/min is correct?
Rate-related symptoms are uncommon in patients with a heart rate less than 150 beats/min.
In which of the following situations is transcutaneous cardiac pacing indicated?
Third-degree AV block in a patient with pulmonary edema
Which of the following is a correct parameter to maintain in an adult patient who remains apneic following return of spontaneous circulation?
Oxygen saturation of 92% to 98%
Which of the following prescribed medications would likley alter the paramedic’s treatment plan when caring for a man with chest pain?
Tadalafil
Successful electrical capture during transcutaneous cardiac pacing is confirmed when you observe which of the following?
Each pacemaker spike is followed by a wide QRS complex
How does the 12-lead ECG of a patient with pericarditis differ from that of acute myocardial infarction?
Reciprocal ST depression is never seen with pericarditis
A 71-year-old woman presents with chest pressure and diaphoresis. Her cardiac rhythm is shown. Her BP is 164/88 mm Hg, pulse is 60 beats/min and strong, respirations are 16 breaths/min, and oxygen saturation is 95%. Which of the following is indicated?
12-lead ECG
Which of the following signs or symptoms occurs more commonly in patients with stable angina than in those with unstable angina?
Chest pain that begins during exertion
Which of the following ECG findings indicates a pathologic delay at the AV node?
PR interval of 230 ms
The high lateral wall of the left ventricle is viewed by which of the following ECG leads?
I and aVL
The cardiac rhythm has wide QRS complexes, is irregular, and has a rate of 180/min. Which of the following should you suspect?
Rapid artial fibrillation
