CARDIOLOGY Flashcards
Atropine sulfate exerts its therapeutic effect by
Opposing the vagus nerve
Which of the following clinical presentations is MOST 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
What views of the heart are represented by the leads?
(High) Lateral - I, aVL Inferior - II, III, and aVF Septal - V1, V2 Anterior - V3, V4 (Low) Lateral - V5, V6
What anatomical aspects of the heart are represented by the leads?
Lateral (I, aVL, V5, V6) - circumflex artery
Inferior (II, III, and aVF) - R coronary artery
Septal/Anterior (V1-V4) - L anterior descending
When assessing a patient’s pulse, you note that it is fast and has an irregularly irregular pattern. On the basis of these findings, which of the following cardiac rhythms would MOST likely be seen on the cardiac monitor?
Uncontrolled a-fib
You are assessing the cardiac rhythm of a woman with respiratory distress. The rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves vary in shape. Which of the following BEST fits this description?
Multifocal atrial tachycardia
A 35-year-old female experienced a syncopal episode shortly after complaining of palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival, she is conscious and alert, denies any injuries, and states that she feels fine. She further denies any significant medical history. Her vital signs are stable and the cardiac monitor reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this information, which of the following would be the MOST likely cause of her syncopal episode?
Paroxysmal SVT
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 has been successfully intubated and an IV line has been established. As CPR is ongoing, you should:
Administer 10 mL (1 mg) of epinephrine 1:10,000 IV.
In addition to CPR, the recommended treatment sequence for an unresponsive, apneic, and pulseless patient with a regular, wide-complex cardiac rhythm at a rate of 40 beats/min includes:
1 mg of epinephrine every 3 to 5 minutes and treating reversible causes.
Side effects of atropine sulfate may include
Acute urinary retention
EKG dimensions?
small box - 0.04 sec
big box - 0.2 sec
5 big boxes - 1 sec
30 big boxes - 6 sec strip
0.12-0.20 - approx PR interval
less than or equal to 0.12 - QRS complex
A 39-year-old female presents with an acute onset of lightheadedness. The cardiac monitor reveals a tachycardic rhythm at 185 beats/min with QRS complexes that measure 0.08 seconds in duration. Despite vagal maneuvers and adenosine, her cardiac rhythm remains unchanged. She is conscious and alert, has a blood pressure of 118/72 mm Hg, and denies shortness of breath or chest discomfort. You should:
Transport immediately and monitor her en route
A 62-year-old male complains of chest pain, nausea, and weakness. His BP is 118/68 mm Hg, his pulse is 60 beats/min, and his respirations are 18 breaths/min. His medical history includes diabetes, anxiety, and hypertension. He currently takes insulin, tadalafil, lisinopril, and alprazolam. Which of the patient’s medications would MOST likely alter the paramedic’s normal treatment plan?
Tadalafil (Cialis)
What pain descriptions is MOST consistent with a cardiac problem?
Crushing
A patient experiencing a right ventricular infarction would be expected to present with:
ST elevation in leads II, III, and aVF.
think inferior
In older adults, an S3 heart sound:
Signifies moderate heart failure.
You have defibrillated a patient who presented with ventricular fibrillation. After 2 minutes of CPR, you reassess the patient’s cardiac rhythm and see a wide-complex tachycardia. You should:
Check for a carotid pulse and defibrillate if a pulse is absent.
Paramedics are attempting to resuscitate a 71-year-old female who is pulseless and apneic. The cardiac monitor reveals ventricular fibrillation, which has persisted after four shocks, two doses of epinephrine, and two doses of amiodarone. Upon receiving information that the patient has chronic renal failure, the paramedic should administer:
1 g of calcium chloride
Treatment for a suspected hyperkalemic arrest includes calcium chloride (1 g) and sodium bicarbonate (1 mEq/kg).
A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are using a microdrip administration set (60 gtts/mL), how many drops per minute should you deliver to achieve the required dose?
36
First, convert the patient’s weight from pounds to kilograms: 145 ÷ 2.2 = 66 kg. Next, determine the desired dose: 15 µg/kg/min × 66 kg = 990 µg/min. The next step is to determine the concentration of dopamine on hand: 800 mg ÷ 500 mL = 1.6 mg/mL (1,600 µg/mL [1.6 × 1,000 = 1,600]). Now, you must determine the number of mL to be delivered per minute: 990 µg/min [desired dose] ÷ 1,600 µg/mL [concentration on hand] = 0.6 mL/min. The final step is to determine the number of drops per minute that you must set your IV flow rate at: 0.6 mL/min × 60 gtts/mL (drop factor of the microdrip) ÷ 1 (total infusion time in minutes) = 36 gtts/min.
You are assessing a 75-year-old male who experienced a sudden onset of slurred speech, a right-sided facial droop, and left-sided hemiparesis approximately 45 minutes ago. His blood pressure is 170/94 mm Hg, pulse rate is 68 beats/min and irregular, and respirations are 14 breaths/min and unlabored. His oxygen saturation is 92% on room air. The MOST appropriate treatment for this patient includes:
Supplemental oxygen via nasal cannula, cardiac monitoring, blood glucose assessment, an IV of normal saline set to keep the vein open, and prompt transport.
During resuscitation of a 60-year-old man with ventricular fibrillation, you restore spontaneous circulation following CPR, defibrillation, two doses of epinephrine, and one dose of amiodarone. The patient remains unresponsive and apneic. Which of the following represents the MOST appropriate post-arrest care for this patient?
Ventilate at a rate of 10 to 12 breaths/min, support blood pressure, and consider therapeutic hypothermia
When administering a sympathomimetic medication, you must be alert for:
Cardiac dysrhythmias
Sympathomimetic medications, such as epinephrine and norepinephrine, cause increases in myocardial oxygen demand and consumption. If given to patients with hypoxemia or acute coronary syndrome (eg, unstable angina, acute myocardial infarction), this effect can result in cardiac dysrhythmias.
A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side weakness. According to his daughter, he has high blood pressure and has had several “small strokes” over the past 6 months. Your partner applies supplemental oxygen; assesses his vital signs, which are stable; and assesses his blood glucose level, which reads 35 mg/dL. You attempt to perform the Cincinnati Prehospital Stroke test, but the patient is unable to understand your instructions. After establishing IV access, you should:
administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities, and transport.
You are evaluating a regular cardiac rhythm in lead II. The rate is 90 beats/min, the QRS complexes consistently measure 0.16 seconds, and inverted P waves are seen immediately following each QRS complex. The rhythm described is MOST characteristic of a/an:
Accelerated junctional rhythm with ventricular aberrancy.
A junctional rhythm is characterized by inverted P waves in lead II. If seen, the inverted P waves precede or follow the QRS complex. At a rate of 90 beats/min, the rhythm is further defined as an accelerated junctional rhythm.
The main purpose of listening to heart sounds is to:
Determine if the cardiac valves are functioning properly.
At the end of ventricular relaxation, the left ventricle contains 110 mL of blood. This is referred to as the:
Prelaod
ECG indicators of Wolff-Parkinson-White (WPW) syndrome include:
Short PR intervals, delta waves, and QRS widening.
Wolff-Parkinson-White (WPW) syndrome is a condition in which accessory pathways - called the bundle of Kent - bypass the atrioventricular (AV) node, causing the ventricles to depolarize earlier than normal (preexcitation). Because the normal delay at the AV node does not occur, the PR intervals in patients with WPW are usually less than 0.12 seconds (120 ms). When conduction occurs down the AV node and simultaneously along the bundle of Kent in an anterograde fashion, the two waves of depolarization meet (fusion). This manifests on the ECG as a delta wave - slurring or notching at the beginning of the QRS complex - which may cause QRS widening.
After performing synchronized cardioversion on an unstable patient with a wide-complex tachycardia, you look at the monitor and see coarse ventricular fibrillation. The patient is unresponsive, apneic, and pulseless. You should:
Start CPR, ensure the synchronize mode is off, and defibrillate.
When attempting transcutaneous cardiac pacing (TCP), you will know that electrical capture has been achieved when:
Each pacemaker spike is followed by a wide QRS complex.
What are the therapeutic effects of aspirin when given to patients experiencing an acute coronary syndrome?
Prevents platelet aggregation
You are transporting a 60-year-old woman with chest discomfort and shortness of breath. The 12-lead ECG indicates an acute anterior wall MI. The patient is receiving oxygen and an IV has been established. You have administered 324 mg of aspirin, 3 sublingual nitroglycerin, and 5 mg of morphine. Which of the following should concern you the MOST during transport?
An acute cardiac dysrhythmia
What is Ondansetron used for and what dose?
(Zofran) treats nausea. 4 mg
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.
When obtaining a 12-lead ECG, lead V1 should be placed:
In the fourth intercostal space just to the right of the sternum.
What cardiac rhythms is associated with bradycardia, and is characterized by regular R-R intervals and a greater ratio of P waves to QRS complexes?
Third-degree AV block
Which of the following 12-lead ECG findings signifies a left bundle branch block?
QRS duration of 124 ms; terminal S wave in lead V1
A QRS duration of greater than 120 ms (0.12 seconds [3 small boxes]) in the context of a supraventricular rhythm indicates a bundle branch block.
Cardioversion involves delivering a shock that is synchronized to occur during the:
R wave
When treating an adult patient with a blood pressure of 60/40 mm Hg, confusion, a heart rate of 40 beats/min, and sinus bradycardia on the cardiac monitor, you should administer supplemental oxygen, establish vascular access, and then:
Administer 0.5 mg of atropine sulfate and consider transcutaneous cardiac pacing.
A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you should:
Administer up to 325 mg of aspirin.
No nitro bc no line and no vitals
When assessing lead II in a patient with a heart rate of 70 beats/min, the Q-T interval is considered prolonged if it is:
Greater than one half of the R-R interval.
A 47-year-old male took two of his prescribed nitroglycerin tablets prior to calling EMS. When you arrive at the scene, the patient tells you that he has a throbbing headache and is still experiencing chest pain. Your MOST immediate suspicion should be that:
He is experiencing continued myocardial ischemia.
Where is the point of maximal impulse (PMI) located in most people?
Left anterior chest, in the midclavicular line, at the fifth intercostal space
What are the therapeutic effects of morphine sulfate when administered to a patient with cardiogenic pulmonary edema?
Increased venous capacitance and decreased preload
You are assessing a 59-year-old woman who complains of chest pressure. When you are looking at her list of medications, you note that she takes Vasotec. What type of medication is this?
ACE inhibitor
Angiotensin II, a potent chemical produced by the kidneys that causes vasoconstriction, is formed from angiotensin I in the blood by the angiotensin converting enzyme. ACE inhibitors block the activity of this enzyme, which decreases the production of angiotensin II. As a result, the blood vessels dilate and blood pressure is reduced
You are assessing a man with a acute chest pain. As you are inquiring about the quality of his pain, he clenches his fist. This is called ______ sign and nonverbally conveys a feeling of:
Levine’s, pressure
Which of the following causes of pulseless electrical activity (PEA) would be the MOST likely to respond to immediate treatment in the prehospital setting?
Hypovolemia
A 59-year-old male presents with chest pressure and nausea. His BP is 106/60 mm Hg, his pulse is 68 beats/min and regular, his respirations are 16 breaths/min and unlabored, and his oxygen saturation is 97%. The 12-lead ECG reveals a sinus rhythm with 3-mm ST elevation in leads II, III, and aVF, and ST depression in leads I and aVL. After administering aspirin, the paramedic should:
Obtain a right-sided 12-lead ECG and establish IV access.
When a patient presents with evidence of acute inferior infarct (ST elevation in leads II, III, and aVF; ST depression in leads I and aVL), the paramedic should obtain a right-sided ECG to look for evidence of right ventricular involvement (ST elevation in lead V4R). If right ventricular involvement is noted, nitroglycerin should not be administered; instead, fluid boluses should be given.
Occlusion of the right coronary artery would MOST likely result in:
Sinoatrial node failure.
The SA node receives blood from the right coronary artery (RCA); therefore, if the RCA is occluded (ie, acute myocardial infarction), the SA node will become ischemic and may cease functioning. If this occurs, the atrioventricular (AV) node would likely assume the role of the primary pacemaker, although at an inherently slower rate.
A patient experiencing a right ventricular infarction would be expected to present with:
ST elevation in leads II, III, and aVF.
A right ventricular infarction (RVI) should be suspected when a patient presents with ECG changes indicative of an inferior wall injury pattern (equal to or greater than 1-mm ST elevation in leads II, III, and aVF; reciprocal ST depression and T wave inversion in leads I and aVL) AND has equal to or greater than 1-mm ST elevation in lead V4R when a right-sided 12-lead ECG is obtained.
A clinically unstable patient presents with an irregular narrow-complex tachycardia at a rate of 170 per minute. What is the recommended initial energy setting for synchronized cardioversion?
120 to 200 joules
Which of the following electrolytes moves slowly into the cardiac cell and maintains the depolarized state of the cell membrane?
Calcium
