Cardiac

Question 1

What are the three signs of Beck’s triad for identification of cardiac tamponade?

Answer 1

Hypotension, jugular venous distention, muffled heart sounds

Question 2

When attempting to delineate between cardiac emergencies, your history and physical exam reveals recent chest pain that improves when leaning forward and a pericardial friction rub on auscultation. Which cardiac emergency do you believe the patient is suffering from?

Answer 2

Pericarditis

Question 3

How does the lead placement vary in a 15-lead ECG?

Answer 3

• Acquire standard 12-lead
• V4 to V4R on corresponding R anterior chest
• V5 to V8 at 5th intercostal space posterior left back midscapular line
• V6 to V9 at 5th intercostal space posterior left back, paraspinal line next to V8
• Run another 12-lead. Relabel V4 > V4R, V5 > V8, and V6 > V9

Question 4

What are the definition and equation that represent cardiac output?

Answer 4

Amount of blood pumped by the heart in one minute: CO (cardiac output) = SV (stroke volume) X HR (heart rate)

Question 5

The method of mechanically restoring perfusion to blocked or constricted coronary arteries is know as?

Answer 5

Percutaneous transluminal coronary angioplasty (PTCA)

Question 6

Why are patients with atrial fibrillation or flutter with a rapid ventricular response often hypotensive?

Answer 6

Decreased atrial kick and cardiac output

Question 7

Why are nitrates and opioids used with caution in patients with right ventricular infarction?

Answer 7

Nitrates and opioids may reduce preload which will ultimately diminish pulmonary perfusion and left-sided cardiac output, thus dropping blood pressure

Question 8

When attempting to treat malignant hypertension, what is the target when reducing blood pressure?

Answer 8

The initial blood pressure should not be reduced by more than 10-15%

Question 9

What is the relationship between the QRS complex and the ejection fraction?

Answer 9

The greater the width of the QRS complex the lower the ejection fraction

Question 10

Where is the infarction if ST elevation occurs in leads II, III, and AVF?

Answer 10

Inferior wall

Question 11

If cardiogenic shock stems from the right side of the heart, what medications do you want to avoid and why?

Answer 11

Medications which reduce preload such as diuretics, morphine, and nitroglycerin since they will cause further hypotension

Question 12

How is a non-ST elevation myocardial infarction diagnosed?

Answer 12

Elevation or serum cardiac enzymes

Question 13

Transportation with an intraaortic balloon pump (IABP) requires monitoring for which complications?

Answer 13

Limb ischemia, infection, thrombus formation, arterial damage, and malpositioning of the balloon

Question 14

Why is it imperative to correct rapid ventricular rate in patients with anomalies of the mitral valve?

Answer 14

Susceptibility to congestive heart failure

Question 15

What is the standard anti-platelet medication used in acute coronary syndrome?

Answer 15

Aspirin

Question 16

What is the proper needle placement for pericardiocentesis?

Answer 16

Insert the needle at the left costal arch and advance towards the tip of the left shoulder or directly cephalad

Question 17

How does nitroglycerin achieve decreasing myocardial oxygen demand?

Answer 17

By reducing preload and afterload

Question 18

What does an imbalance between myocardial oxygen supply and demand cause?

Answer 18

Myocardial ischemia and eventually infarction if not corrected

Question 19

Patients with congestive heart failure will exhibit what changes in central venous pressure (CVP) and systemic vascular resistance (SVR)?

Answer 19

Increased

Question 20

When traditional therapies of oxygen, nitrates, lasix and morphine prove unsuccessful in treating congestive heart failure, what non-invasive technique may be added to the treatment regimen?

Answer 20

CPAP (continuous positive airway pressure) or BiPAP

Question 21

What additional findings do women present with to make their presentation of acute coronary syndrome differ from that of men?

Answer 21

Indigestion, dizziness, nausea, vomiting, discomfort between shoulder blades, sense of impending doom, unexplained fatigue

Question 22

How do beta blockers decrease myocardial oxygen demand?

Answer 22

By decreasing heart rate and contractility

Question 23

During what portion of the cardiac cycle does the intraaortic balloon pump (IABP) inflate?

Answer 23

Diastole

Question 24

Where does the tip of a transvenous temporary pacer terminate?

Answer 24

Right ventricle

Question 25

How does intravenous nitroglycerin work to improve ischemic chest pain?

Answer 25

Directly vasodilates the systemic and coronary blood vessels to improve blood flow

Question 26

A patient who displays diminished femoral pulses with hypotension should pose a high index of suspicion for what?

Answer 26

Abdominal aortic aneurysm

Question 27

Tall or peaked T waves on an electrocardiogram are indicative of what electrolyte imbalance?

Answer 27

Hyperkalemia (elevated potassium)

Question 28

What is the major difference between aortic dissection and aortic aneurysm?

Answer 28

Aortic dissection causes bleeding where a false lumen is created between the layers of the vessel whereas an aneurysm tears through all three layers of the lumen and bleeds into the thoracic or abdominal cavity

Question 29

A septal wall acute myocardial infarction (AMI) will show ST elevation in which leads?

Answer 29

V1 and V2

Question 30

What can be administered to a patient suffering from a right ventricular myocardial infarction to increase central venous pressure?

Answer 30

Intravenous fluid Boris