Cardiac Emergencies

Question 1

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

Answer 1

CPAP (continuous positive airway pressure) or BiPAP

Question 2

How does intravenous nitroglycerin work to improve ischemic chest pain?

Answer 2

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

Question 3

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

Answer 3

Intravenous fluid bolus

Question 4

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

Answer 4

Aspirin

Question 5

Where does the tip of a transvenous temporary pacer terminate?

Answer 5

Right ventricle

Question 6

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

Answer 6

Susceptibility to congestive heart failure

Question 7

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

Answer 7

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

Question 8

How is a non-ST elevation myocardial infarction diagnosed?

Answer 8

Elevation of serum cardiac enzymes

Question 9

How does nitroglycerin achieve decreasing myocardial oxygen demand?

Answer 9

By reducing preload and afterload

Question 10

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

Answer 10

Decreased atrial kick and cardiac output

Question 11

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

Answer 11

V1 and V2

Question 12

What is the proper needle placement for pericardiocentesis?

Answer 12

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

Question 13

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

Answer 13

20-25% of the mean arterial pressure or diastolic blood pressure of 100-110mmHg

Question 14

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

Answer 14

Hypotension, jugular venous distention, and muffled heart tones

Question 15

What are the definition and equation that represent cardiac output?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

How does the lead placement vary in a right-sided EKG?

Answer 17

The precordial leads are placed in a mirrored position on the right sided of the chest rather then the left

Question 18

How do beta blockers decrease myocardial oxygen demand?

Answer 18

By decreasing heart rate and contractility

Question 19

Transportation of what device involves monitoring for complications such as limb ischemia, infection, thrombus formation, arterial damage and malpositioning of the balloon?

Answer 19

Intraaortic balloon pump (IABP)

Question 20

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

Answer 20

Percutaneous transluminal coronary angioplasty (PTCA)

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 the shoulder blades, sense of impending doom, unexplained fatigue

Question 22

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

Answer 22

Abdominal aortic aneurysm

Question 23

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

Answer 23

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

Question 24

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

Answer 24

Pericarditis

Question 25

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

Answer 25

Inferior wall

Question 26

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

Answer 26

Hyperkalemia (elevated potassium)

Question 27

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

Answer 27

Increased

Question 28

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

Answer 28

Myocardial ischemia and eventually infarction if not corrected

Question 29

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

Answer 29

Diastole

Question 30

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

Answer 30

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