Cardiology

Question 1

You arrive approximately 8 minutes after a 51-year-old male collapsed at a family event. After determining that he is unresponsive and apneic, you should:

A) assess for a carotid pulse for 5 to 10 seconds.
B) give 2 rescue breaths and check for a pulse.
C) begin CPR, starting with chest compressions.
D) immediately assess the patient’s cardiac rhythm.

Answer 1

Answer: A

After determining that an adult patient is unresponsive and apneic, you should assess for a carotid pulse for at least 5 seconds but no more than 10 seconds. If the patient has a pulse, open the airway and provide rescue breathing. If the patient does not have a pulse, begin CPR (starting with chest compressions), then open the airway and give 2 rescue breaths. Assess the patient’s cardiac rhythm as soon as an AED is available.

Question 2

A 57-year-old man complains of a dull pain in his chest. He tells you that he has had two heart attacks within the past 3 years and is currently being treated for hypertension. After administering supplemental oxygen, you should:

A) obtain a complete set of vital signs.
B) administer up to 324 mg of baby aspirin.
C) inquire about any medications he is taking.
D) give him 0.4 mg of nitroglycerin sublingual.

Answer 2

Answer: B

According to current Emergency Cardiac Care guidelines, a patient with a suspected acute coronary syndrome should be given supplemental oxygen (as needed to maintain an SpO2 of greater than 94%) and aspirin (160 to 325 mg) as soon as possible. Aspirin blocks the formation of thromboxane A2, which inhibits platelet aggregation and coronary vasoconstriction. Nitroglycerin (NTG), up to three 0.4-mg sublingual doses, is also indicated for patients with suspected cardiac-related chest pain or discomfort; however, you should first establish intravenous access. NTG is a vasodilator and could cause a drop in his blood pressure. Vital signs should be obtained early; however, oxygen and aspirin are interventions that should be performed immediately.

Question 3

You analyze a cardiac arrest patient’s rhythm with the automated external defibrillator (AED) and receive a no shock message. What should you do next?

A) Give 2 breaths and resume chest compressions
B) Resume CPR starting with chest compressions
C) Check for a pulse for no longer than 10 seconds
D) Continue rescue breathing and transport at once

Answer 3

Answer: B

If you receive a shock advised message from the AED, you should deliver the shock at once and then begin or resume CPR, starting with chest compressions. If you receive a no shock message from the AED, you should immediately resume CPR, starting with chest compressions, and reanalyze the patient’s cardiac rhythm after 2 minutes. Checking for a pulse immediately after defibrillation causes an unnecessary delay in performing chest compressions. You should continue the cycles of CPR, analyzing the cardiac rhythm and delivering a shock (if indicated), and immediately resuming CPR until paramedics arrive or the patient starts to move.

Question 4

Pale or ashen skin in a patient experiencing an acute myocardial infarction indicates:

A) poorly oxygenated blood caused by respiratory failure.
B) poor cardiac output and reduced peripheral perfusion.
C) hypertension and increased peripheral vascular resistance.
D) peripheral vasodilation caused by reduced sympathetic tone.

Answer 4

Answer: B

Pale or ashen skin indicates reduced peripheral perfusion. In a patient experiencing an acute myocardial infarction (AMI), this is often caused by poor cardiac output. Cyanosis, a blue or purple tint to the skin, is a sign of poor oxygenation of circulating blood; it occurs in patients with respiratory failure. Hypertension typically causes flushing (red) skin, not pallor. Peripheral vasodilation, as seen in patients with heat-related illnesses, also causes flushing of the skin. AMI is typically associated with increased, not decreased, sympathetic nervous system tone.

Question 5

In contrast to atherosclerosis, arteriosclerosis:

A) is a thickening of the arterial walls, resulting in a loss of elasticity and a reduction in blood flow.
B) occurs when the coronary arteries constrict, which significantly decreases blood flow to the heart.
C) is a disorder in which cholesterol builds up and forms a plaque inside the walls of blood vessels.
D) occurs when the inner layers of the arterial wall become separated, allowing blood to flow between the layers.

Answer 5

Answer: A

Arteriosclerosis is a thickening of the arterial walls, which causes a loss of elasticity (hardening of the arteries) and a subsequent reduction in blood flow. Atherosclerosis is a process in which cholesterol and other fatty substances build up and form a plaque inside the walls of blood vessels, which obstructs blood flow and interferes with their ability to dilate or contract. Prinzmetal angina, also called variant or vasospastic angina, occurs when the coronary arteries constrict and significantly decrease blood flow to the heart. Dissection is the process in which the inner layers of the arterial wall, such as the aorta, become separated and allow blood to flow (at high pressures) in between the layers.

Question 6

Which of the following cardiac dysrhythmias has the GREATEST potential for deteriorating to ventricular fibrillation?

A) Asystole
B) Sinus tachycardia
C) Sinus bradycardia
D) Ventricular tachycardia

Answer 6

Answer: D

Ventricular tachycardia is a dysrhythmia that indicates significant ventricular irritability; therefore, it has the greatest potential for deteriorating to ventricular fibrillation (V-Fib). Asystole, the absence of all electrical and mechanical activity in the heart, is often the result of uncorrected V-Fib.

Question 7

Survival from out-of-hospital cardiac arrest is MOST dependent on:

A) cardiac drug administration.
B) advanced airway management.
C) aggressive paramedic care.
D) early CPR and defibrillation.

Answer 7

Answer: D

Early CPR and defibrillation (if indicated) have consistently shown to be the two most critical interventions for a cardiac arrest patient with regard to survival. High-quality CPR helps to keep the vital organs viable, and early defibrillation can terminate ventricular fibrillation (V-Fib), which is present as the initial dysrhythmia in about 75% of adult out-of-hospital cardiac arrests. Delayed or inadequate CPR has been directly linked to poor outcomes. For each minute that V-Fib persists, the patient’s chance of survival decreases by 7% to 10%. Early advanced cardiac life support (advanced airway management, paramedic care, cardiac drug administration) is an important component in the treatment of the cardiac arrest patient; however, early CPR and defibrillation are the two most vital components in the chain of survival.

Question 8

Which of the following cardiac valves are referred to as semilunar valves?

A) Aortic and mitral
B) Aortic and pulmonic
C) Tricuspid and mitral
D) Tricuspid and pulmonic

Answer 8

Answer: B

The pulmonic (right side of the heart) and aortic (left side of the heart) valves are referred to as semilunar valves. The tricuspid (right side of the heart) and mitral (left side of the heart) valves are referred to as atrioventricular valves.

Question 9

You are transporting a 57-year-old man with chest pain. He is receiving supplemental oxygen and has an intravenous line in place. Suddenly, the patient becomes unresponsive. You should:

A) immediately insert a supraglottic airway device.
B) quickly assess for breathing and check for a pulse.
C) open his airway and look, listen, and feel for breathing.
D) insert an oral airway and begin positive-pressure ventilation.

Answer 9

Answer: B

If you find a patient who is unresponsive, or if a patient becomes unresponsive in your presence, you should quickly assess for breathing and then check for a pulse. Assess for breathing by quickly visualizing the chest for obvious movement. If the patient is not breathing or is not breathing normally (agonal gasps), check for a pulse. If the patient has a pulse, open the airway and provide rescue breathing. If the patient does not have a pulse, begin CPR starting with chest compressions. The technique of look, listen, and feel is no longer recommended; it delays chest compressions if they are needed. The patient may require advanced airway management, but not before performing CPR (if indicated) and establishing a patent airway with basic means first.

Question 10

You are called to a local supermarket where a customer collapsed. The man is approximately 50-years-old and appears to weigh about 180 lb. When you arrive, two bystanders are performing CPR. Your first action should be to:

A) verify the effectiveness of the bystanders’ CPR.
B) apply the AED and analyze the patient’s cardiac rhythm.
C) insert a supraglottic airway without interrupting CPR.
D) assess the patient to confirm that he is in cardiac arrest.

Answer 10

Answer: D

On arriving at a scene where bystander CPR is in progress, your first action should be to confirm that the patient is in cardiac arrest. Quickly confirm that he is unresponsive and not breathing and check for a pulse for no longer than 10 seconds. If cardiac arrest is confirmed, resume CPR and apply the automated external defibrillator (AED) as soon as possible. Advanced airway management is not an immediate priority during the initial treatment of cardiac arrest.

Question 11

Which of the following clinical presentations is consistent with left-sided heart failure?

A) History of a heart murmur, jugular venous distention, and tachycardia
B) History of diabetes, edema to the ankles, and abdominal distention
C) History of hypertension, dried blood around the mouth, and agitation
D) History of angina, swollen hands and feet, and excessive urination

Answer 11

Answer: C

Congestive heart failure occurs when the lungs or systemic circulation become congested with blood secondary to failure of the heart to effectively pump blood. Common causes of congestive heart failure include acute myocardial infarction, heart valve disease, and chronic hypertension. In left-sided heart failure, the left ventricle is unable to pump blood effectively enough so blood backs up in the lungs. Signs and symptoms include dyspnea; orthopnea (difficulty breathing while lying down); a productive cough with pink frothy sputum (dried blood around the mouth is evidence of this); and restlessness or agitation secondary to reduced cerebral blood flow. Right-sided heart failure occurs when the right ventricle is unable to effectively pump blood to the lungs and results in blood backing up in the systemic circulation. Signs and symptoms include peripheral edema and jugular venous distention. In more severe cases, fluid can accumulate in the peritoneal cavity (ascites), resulting in a painful, distended abdomen.

Question 12

A 61-year-old woman presents with acute chest pain and shortness of breath that woke her from her sleep. She took two of her prescribed nitroglycerin tablets before your arrival, but is still in significant pain. Her BP is 86/52 mm Hg, her heart rate is 110 beats/min, and her respirations are 24 breaths/min and labored. In addition to administering supplemental oxygen, you should:

A) give her up to 325 mg of aspirin, monitor her vital signs, and transport at once.
B) start an IV line, give her a 2 liter normal saline bolus, and transport immediately.
C) place her in a supine position, elevate her legs, and give her 325 mg of aspirin.
D) give her one more NTG tablet, reassess her blood pressure, and transport at once.

Answer 12

Answer: A

The patient’s clinical presentation is consistent with acute myocardial infarction, which is possibly complicated by left-sided congestive heart failure. Her systolic BP is less than 90 mm Hg, which contraindicates further NTG administration. You should give her up to 325 mg of aspirin, monitor her vital signs, and transport at once. Establish vascular access en route and administer enough fluid to maintain adequate perfusion; 2 L of normal saline is a lot of fluid and could easily exacerbate any pulmonary edema she may have. The patient may be a candidate for continuous positive airway pressure (CPAP); however, you must recall that any form of positive-pressure ventilation has a negative effect on cardiac output, and CPAP could cause a further drop in her BP. A supine position should be avoided in patients with labored breathing and possible pulmonary edema because this only makes it more difficult for them to breathe.

Question 13

You and your partner witness the collapse of a middle-aged man. Which of the following represents the MOST correct sequence for assessing and providing care to him?

A) Immediately begin CPR, starting with chest compressions, while your partner quickly retrieves the AED from the ambulance
B) Assess responsiveness and visualize the chest for signs of breathing, check for a pulse, and begin chest compressions if needed
C) Gently tap the patient to see if he responds; open his airway; look, listen, and feel for breathing; and give two rescue breaths if needed
D) Open the airway while assessing responsiveness, give two rescue breaths if needed, and check for a carotid pulse for up to 10 seconds

Answer 13

Answer: B

If you encounter a patient who seems to be unresponsive or if you witness the collapse of a patient, you should assess responsiveness while quickly visualizing the chest for obvious signs of breathing. If the patient is not breathing or is not breathing normally (agonal gasps), assess for a carotid pulse for up to 10 seconds and begin chest compressions if the patient is pulseless. As you begin CPR (30 chest compressions to two rescue breaths), your partner should retrieve the AED and apply it as soon as possible. The technique of look, listen, and feel is no longer recommended because it causes an unnecessary delay in providing chest compressions if the patient is pulseless.

Question 14

A 70-year-old woman was suddenly awakened with the feeling that she was suffocating. She is anxious, is laboring to breathe, and has dried blood on her lips. Which of the following pathophysiologies BEST explains her clinical presentation?

A) Decreased stroke volume with left heart failure
B) Increased preload with left heart failure
C) Decreased preload with right heart failure
D) Increased stroke volume with right heart failure

Answer 14

Answer: A

Paroxysmal nocturnal dyspnea (PND), the sudden awakening from sleep with the feeling of being suffocated, along with the dried blood around the patient’s lips (likely due to coughing up blood-tinged sputum), are classic indicators of left-sided congestive heart failure (CHF). In left-sided CHF, stroke volume (the amount of blood ejected from the ventricle per contraction) is decreased secondary to a weakened or damaged myocardium. Decreased stroke volume causes blood to regurgitate into the upper chamber of the heart and ultimately backs up into the lungs and causes pulmonary edema.

Question 15

The purpose of defibrillation is to:

A) stop all electrical activity in the heart.
B) convert asystole to a perfusing rhythm
C) decrease an excessively rapid heart rate.
D) increase the rate of a slow beating heart.

Answer 15

Answer: A

To defibrillate means to shock the heart with a specialized electrical current (direct current) to stop all electrical activity and restore a normal, rhythmic beat. Defibrillation induces a period of asystole, an absence of all electrical activity, so that a pacemaker in the heart may resume normal cardiac electrical activity. Defibrillation is used to terminate ventricular fibrillation and pulseless ventricular tachycardia; defibrillation is not used to treat asystole. Excessively rapid heart rates are not treated with defibrillation (unsynchronized shock); instead, they are treated with cardioversion (synchronized shock) if the patient is unstable or medication therapy if the patient is stable. Excessively slow heart rates are treated with transcutaneous cardiac pacing, a procedure in which the heart rate is increased by passing small electrical currents through the heart at a preset rate, or with various medications.

Question 16

A 50-year-old man experiences chest discomfort after exerting himself. After resting for 10 minutes and taking one of his prescribed nitroglycerin tablets, the pressure in his chest completely subsides. This scenario MOST accurately describes:

A) unstable angin
B) cardiac necrosis.
C) stable angina.
D) myocardial infarction.

Answer 16

Answer: C

When, for a brief period, the heart muscle is not getting enough oxygen (ischemia), the resultant chest pain, pressure, or discomfort is called angina pectoris. Angina that follows a predictable pattern and is promptly relieved with rest and/or NTG is called stable angina. By contrast, unstable angina does not follow a predictable pattern and is often not relieved by rest and/or NTG. Unstable angina is also referred to as preinfarction angina. Acute myocardial infarction (AMI) occurs when a portion of the heart muscle dies (undergoes necrosis) because of a completely blocked coronary artery. Although the pain characteristics of angina and AMI are the same, angina is often relieved by rest and/or NTG, whereas the pain from an AMI is not.

Question 17

What is the ejection fraction if the ventricle fills with 120 mL of blood and has a stroke volume of 80 mL?

A) 0.59
B) 0.67
C) 0.74
D) 0.8

Answer 17

Answer: B

Ejection fraction is the percentage of blood ejected from a filled ventricle during a single contraction. If the ventricle contains 120 mL before a contraction, and then ejects 80 mL during the contraction (the stroke volume), the ejection fraction is 67% (80 mL / 120 mL = 66.6 [67%]). Normal left ventricular ejection fraction is 55% to 70%.

Question 18

The ability of cardiac cells to respond to electrical impulses is called:

A) excitability.
B) automaticity.
C) conductivity.
D) contractility.

Answer 18

Answer: A

Excitability refers to the cardiac cells’ ability to respond to electrical impulses. Cardiac muscle cells have a special characteristic called automaticity, which is not found in any other type of muscle in the body. Automaticity allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve cell. The ability of the cardiac cells to conduct electrical impulses is called conductivity. Contractility refers to the force with which the heart muscle contracts.

Question 19

Which of the following is NOT a contraindication for administering nitroglycerin?

A) Systolic BP less than 90 mm Hg
B) History of a prior ischemic stroke
C) Recent use of Cialis or Levitra
D) Heart rate less than 50 beats/min

Answer 19

Answer: B

Contraindications to the administration of nitroglycerin (NTG) include a systolic blood pressure less than 90 mm Hg, significant bradycardia (heart rate

Question 20

A 66-year-old woman is diagnosed with cardiomyopathy. What does this indicate?

A) An enlarged myocardium
B) Strengthening of the ventricles
C) Progressive cardiac weakening
D) An occluded coronary artery

Answer 20

Answer: C

Cardiomyopathy is a progressive weakening of the myocardium. This condition is commonly the result of chronic hypertension, multiple myocardial infarctions, or congestive heart failure. An enlarged myocardium is called cardiomegaly.

Question 21

Sudden cardiac arrest in the adult population is MOST often secondary to:

A) a cardiac arrhythmia.
B) myocardial infarction.
C) massive hypovolemia.
D) respiratory failure.

Answer 21

Answer: A

Approximately 75% of adult sudden cardiac arrests are secondary to a cardiac arrhythmia, most frequently ventricular fibrillation (V-Fib). Respiratory failure is the most common cause of cardiac arrest in infants and children.

Question 22

Shortly after administering nitroglycerin to your 51-year-old patient with chest pain, he becomes lightheaded and pale. You reassess his BP and note that it is 84/56 mm Hg. A patent IV line has been established and the patient is receiving supplemental oxygen. You should immediately:

A) place him supine and elevate his legs.
B) give a 20 mL/kg bolus of normal saline.
C) give him 324 mg of aspirin and reassess him.
D) assist his ventilations with a bag-mask device.

Answer 22

Answer: A

Nitroglycerin is a vasodilator, and in some cases, it can cause hypotension. Hypotension in a patient who may be experiencing an acute myocardial infarction could be disastrous. If hypotension occurs after administrating NTG, you should immediately place the patient supine and elevate his or her legs 6 to 12 inches to improve perfusion. An IV fluid bolus may also be indicated, but elevating the patient’s legs is faster than infusing 500 mL of normal saline. Aspirin is not a vasodilator and has no effect on the blood pressure. Furthermore, aspirin would have been given prior to NTG anyway. There is no evidence in this scenario that indicates the patient is breathing inadequately; therefore, assisted ventilation is not necessary at this time.

Question 23

Which of the following statements regarding the chest pain or discomfort associated with acute myocardial infarction is correct?

A) It is severe, but generally subsides within 30 minutes
B) It does not change with breathing or body movement
C) It is typically described by the patient as a sharp feeling
D) It is often pleuritic in nature and is made worse by breathing

Answer 23

Answer: B

The chest pain or discomfort associated with acute myocardial infarction (AMI) is often described by the patient as pressure, crushing, or squeezing, and is not affected by breathing or other body movement. Pleuritic (sharp) chest pain that is made worse by breathing is common with a spontaneous pneumothorax or pulmonary embolism; it is not common in patients experiencing an AMI. Unlike anginal chest pain, which often subsides within 15 minutes after rest or nitroglycerin, the pain associated with an AMI can last from 30 minutes to several hours.

Question 24

Common signs of acute left heart failure with pulmonary edema include:

A) jugular vein distention.
B) ascites and bradycardia.
C) hypertension and tachycardia.
D) peripheral edema and hypotension.

Answer 24

Answer: C

Hypertension and tachycardia are commonly associated with acute left heart failure and pulmonary edema. These signs are the result of a sympathetic discharge of epinephrine to increase cardiac contractility and improve cardiac output. Jugular vein distention, peripheral edema, and ascites (fluid accumulation in the peritoneum) are common findings associated with chronic right-sided heart failure.

Question 25

Which of the following BEST describes the pathophysiology of acute myocardial infarction?

A) Progressive coronary artery narrowing, which limits blood flow and causes acute chest pain
B) Spasm of a coronary artery, which causes ischemia to the portion of the heart distal to the spasm
C) Acute, reversible myocardial ischemia secondary to an imbalance in oxygen supply and demand
D) Plaque rupture, which activates the blood-clotting system and acutely obstructs a coronary artery

Answer 25

Answer: D

Acute myocardial infarction occurs when, for reasons not completely understood, a brittle plaque develops a crack, exposing the inside of the atherosclerotic wall. Acting like a torn blood vessel, the jagged edge of the crack activates the body’s blood-clotting system, which causes platelets to aggregate and form a clot; this acutely obstructs the coronary artery. If blood flow is not promptly reestablished, either with fibrinolytic (clot-buster) therapy or the placement of a coronary stent, myocardial tissue distal to the occlusion becomes necrotic (it will die). The acute, but reversible process in which myocardial oxygen demand exceeds its supply is called angina pectoris. Angina is the primary symptom of coronary artery disease.

Question 26

Assessment and management of a conscious female with suspected cardiac-related chest pain might include all of the following, EXCEPT

A) auscultation of breath sounds.
B) inquiring as to when the patient last ate.
C) administering 325 mg of enteric-coated aspirin.
D) inquiring about a history of cardiac problems.

Answer 26

Answer: C

Early administration of aspirin has clearly been shown to reduce mortality and morbidity from acute coronary syndrome. However, chewable baby aspirin (160 to 325 mg), should be given; enteric-coated aspirin does not act nearly as fast as chewable baby aspirin. Auscultation of breath sounds should be performed on any patient with a suspected cardiac or respiratory problem. A SAMPLE history should also be obtained, which includes questions regarding the patient’s past medical history and when he or she last ate or drank anything.

Question 27

A 56-year-old man presents with confusion; a weak, thready pulse; and a blood pressure of 74/56 mm Hg after 2 days of chest pain. In addition to supplemental oxygen, treatment should include:

A) a semi-Fowler position.
B) 0.4 mg of nitroglycerin.
C) a crystalloid fluid bolus.
D) lower extremity elevation.

Answer 27

Answer: C

The patient’s signs and symptoms and history of chest pain are consistent with cardiogenic shock. You should be suspicious that he experienced an acute myocardial infarction and is now in shock secondary to heart failure. Treatment for cardiogenic shock includes high-flow oxygen or assisted ventilation if necessary; crystalloid fluid boluses if hypotension is present (be sure and monitor breath sounds for evidence of pulmonary edema); prevention of hypothermia; and prompt transport. Nitroglycerin is contraindicated for this patient because of his hypotension. Position the patient comfortably. If evidence of pulmonary edema is present (dyspnea or crackles in the lungs), a semi-Fowler position should be used. However, if the patient is hypotensive, as is the patient in this scenario, the patient should be placed in a supine position. Elevation of the lower extremities may only make it difficult for the patient to breathe and should be avoided. Follow your local protocols.

Question 28

A patient with an acute onset of chest discomfort and diaphoresis has a heart rate of 120 beats/min. What is the MOST detrimental effect that his heart rate can have on his clinical condition?

A) Decreased myocardial irritability
B) Decreased myocardial contractility
C) Increased nervousness and anxiety
D) Increased myocardial oxygen demand

Answer 28

Answer: D

Your patient has signs and symptoms of acute myocardial infarction (ie, chest discomfort, diaphoresis). Any increase in cardiac workload, such as an increased heart rate or blood pressure, increases the amount of oxygen that the myocardium demands and consumes. This could extend (enlarge) the area of myocardial infarction.

Question 29

A 56-year-old woman complains of crushing substernal chest pain that radiates to her jaw. During your primary assessment, you note that she is conscious and alert; has unlabored respirations; and a rapid, irregular pulse. You should:

A) start an IV line at the scene, give her oxygen, and then nitroglycerin.
B) transport at once and apply the AED to her en route to the hospital.
C) give her oxygen and aspirin and prepare for immediate transport.
D) administer up to 3 doses of nitroglycerin and obtain her vital signs.

Answer 29

Answer: C

The patient in this scenario should be assumed to be experiencing an acute coronary syndrome (ACS), a clinical term used to describe unstable angina or acute myocardial infarction. A rapid, irregular pulse suggests the presence of a cardiac dysrhythmia. You should give the patient oxygen, administer aspirin (160 to 325 mg), and prepare for immediate transport. Patients experiencing an ACS are at highest risk for cardiac arrest within the first few hours; therefore, prompt transport is essential. En route to the hospital, you can obtain her vital signs, establish IV access, and, if needed, give her nitroglycerin. It is also important to notify the receiving facility as soon as possible. The automated external defibrillator is not indicated for her because she is not in cardiac arrest. If your transport time will be lengthy, you should consider a paramedic intercept.

Question 30

Which of the following statements regarding the automated external defibrillator (AED) is correct?

A) It should be applied to any patient who complains of chest pain
B) It will analyze the cardiac rhythm of a patient in a moving ambulance
C) It can safely be used on patients who are less than 1 year of age
D) It will only shock patients with ventricular tachycardia without a pulse

Answer 30

Answer: C

Although a manual defibrillator is preferred over the AED for patients less than 1 year of age, an AED should be used if a manual defibrillator is not available. You should use pediatric pads with a dose attenuator (energy reducer). However, if these are not available, you should use adult AED pads. The AED does not analyze the cardiac rhythm of a patient who is moving; therefore, it cannot be used in the back of a moving ambulance. The AED identifies and defibrillates ventricular fibrillation and pulseless ventricular tachycardia. The AED is only applied to patients who are unresponsive, apneic, and pulseless.

Question 31

Signs or symptoms of right-sided heart failure include:

A) nocturnal dyspne
B) persistent orthopnea.
C) jugular venous distention.
D) crackles heard in the lungs.

Answer 31

Answer: C

As the right side of the heart fails, blood is not effectively pumped to the lungs; therefore, it backs up beyond the right atrium and into the systemic venous system. This is most noticeable by the presence of engorged or distended jugular veins. Other signs of right-sided heart failure include peripheral edema and ascites (accumulation of fluid in the peritoneum). Orthopnea, paroxysmal nocturnal dyspnea, and coughing up blood-tinged sputum (hemoptysis) indicate fluid in the lungs and are indicators of left-sided heart failure. Crackles (formerly called rales), are fine, moist, thin sounds that indicate fluid in the smaller lower airways; they are also associated with left-sided heart failure.

Question 32

A middle-aged man complains of heaviness in his chest and shortness of breath. He is conscious and alert, his airway is patent, and his breathing is labored. As your partner is preparing to administer supplemental oxygen, you should:

A) have the patient chew and swallow four baby aspirin.
B) administer 0.4 mg of nitroglycerin and assess his BP.
C) start an IV line and set the rate to keep the vein open.
D) perform a detailed secondary assessment of the patient.

Answer 32

Answer: A

Aspirin (160 to 325 mg) has clearly been shown to reduce mortality and morbidity in patients experiencing an acute coronary syndrome (eg, unstable angina, acute myocardial infarction) and should be given as soon as possible. As your partner is preparing to administer oxygen, instruct the patient to chew and swallow up to four baby aspirin. It is potentially dangerous to administer NTG without a patent IV line, and it should not be given before assessing the patient’s blood pressure (NTG is contraindicated if the patient’s systolic blood pressure is

Question 33

How does the chest pain associated with acute myocardial infarction differ from that of angina pectoris?

A) It is influenced by coughing, deep breathing, or other body movements
B) It is typically described by the patient as a feeling of heaviness or pressure
C) It occurs more often during exertion than when a person is resting or sleeping
D) It lasts longer than 15 minutes and increases in frequency or duration

Answer 33

Answer: D

The pain characteristics of angina pectoris and acute myocardial infarction (AMI) are essentially identical. The patient often describes the pain as a feeling of heaviness or pressure in the chest, which may radiate to the arm, jaw, or back. Cardiac-related chest pain, whether caused by angina or AMI, is not influenced by coughing, deep breathing, or other body movements. Although the onset of pain associated with AMI can occur during exertion, it more often occurs when the patient is resting or sleeping. Anginal pain typically lasts less than 15 minutes, whereas the pain associated with AMI lasts longer than 15 minutes and increases in frequency and duration.

Question 34

Treatment for a semiconscious patient with left-sided heart failure and pulmonary edema would MOST likely include:

A) positive-pressure ventilation.
B) a supine or shock position.
C) insertion of a King airway.
D) isotonic crystalloid boluses.

Answer 34

Answer: A

Pulmonary edema impairs pulmonary (external) respiration - the exchange of oxygen and carbon dioxide in the lungs. If a patient with left-sided heart failure presents with evidence of pulmonary edema (labored breathing, crackles in the lungs, and hemoptysis), treatment depends on the adequacy of ventilation and the patient’s ability to follow commands. If the patient is able to follow commands and has adequate ventilation, administer oxygen via nonrebreathing mask. If the patient is able to follow commands, but has inadequate ventilation, continuous positive airway pressure (CPAP) should be applied. If the patient is unable to follow commands and has inadequate ventilation, you should assist his or her breathing with a bag-mask device. A supine position should be avoided because this further impairs the patient’s ability to breathe. Unless the patient is hypotensive, intravenous fluid boluses should not be given. Advanced airway devices (ie, King LT, LMA, Combitube) are only indicated for patients who are unresponsive and do not have a gag reflex.

Question 35

Cardiogenic shock can be differentiated from hypovolemic shock by the presence of:

A) dyspne
B) restlessness.
C) tachycardia.
D) pallor.

Answer 35

Answer: A

Cardiogenic shock, often caused by acute myocardial infarction (AMI), occurs when the heart fails as an effective pump and can no longer meet the metabolic needs of the body. It can occur immediately or as late as 24 hours after an AMI. Many of the signs and symptoms that are seen in patients with hypovolemic shock occur in patients with cardiogenic shock, including restlessness, tachycardia, and diaphoresis. The presence of dyspnea, a feeling of shortness of breath, suggests that blood is backing up into the lungs (pulmonary edema); it is not commonly seen in patients with hypovolemic shock.

Question 36

Which of the following arteries branch from the ascending aorta?

A) Coronary and brachiocephalic arteries
B) Common iliac and left carotid arteries
C) Right and left main coronary arteries
D) Innominate and left subclavian arteries

Answer 36

Answer: C

The aorta is divided into three sections: the ascending aorta, the aortic arch, and the descending aorta. The ascending aorta arises from the left ventricle and consists of only two branches: the right and left main coronary arteries. The aorta then arches posteriorly and to the left, forming the aortic arch. Three major arteries arise from the aortic arch: the brachiocephalic (innominate) artery, the left common carotid artery, and the left subclavian artery. The descending aorta is the longest section of the aorta and is subdivided into the thoracic aorta and the abdominal aorta. It extends through the thorax and abdomen and into the pelvis. In the pelvis, the descending aorta divides into the two common iliac arteries, which further divide into the internal and external iliac arteries.

Question 37

Which of the following statements regarding cardiovascular disease is correct?

A) Cardiovascular disease is the second leading cause of death in the United States
B) More men have cardiovascular disease than women, but more women die of heart disease than men
C) The symptoms of cardiovascular disease are typically more obscure in men than they are in women
D) Most “silent heart attacks” occur in elderly men who have a history of hypertension

Answer 37

Answer: B

Cardiovascular disease is the leading cause of death in the United States; the second leading cause of death is cancer. Although more men have cardiovascular disease, more women die of cardiovascular disease because their symptoms are often obscure and not as clear-cut. Elderly women with a history of diabetes are the most likely to present with vague or atypical signs and symptoms of cardiovascular disease; therefore, the incidence of “silent heart attacks” is highest in this patient population.

Question 38

Which of the following clinical presentations is MOST consistent with an acute ischemic stroke involving the left cerebral hemisphere?

A) Aphasia, lethargy, right side hemiparalysis, right side facial droop
B) Dysarthria, confusion, right side hemiparesis, left side facial droop
C) Dysphasia, confusion, left side hemiparesis, right side facial droop
D) Decerebrate posturing, asymmetric pupils, hypertension, bradycardia

Answer 38

Answer: B

Acute ischemic strokes represent approximately 75% of all strokes. Each cerebral hemisphere controls functions on the contralateral (opposite) side of the body; therefore, sensory and motor deficits (ie, hemiparesis, hemiparalysis) are observed on the side of the body opposite the stroke. However, because the facial nerves do not decussate (cross as they leave the cerebral cortex, move through the brainstem, and arrive at the spinal cord), facial droop is typically observed on the ipsilateral (same) side as the stroke. Pupillary changes, if present, will also occur on the same side as the stroke because of optic nerve crossover in the brain. Other common signs of acute ischemic stroke include dysarthria (slurred speech), dysphasia (difficulty speaking or understanding), aphasia (inability to speak or understand), and mental status changes. In contrast to acute ischemic stroke, acute hemorrhagic stroke (caused by a ruptured cerebral artery) typically presents with more ominous signs, which include a sudden, severe headache that is followed by a rapid decline in level of consciousness. Because bleeding is occurring within the brain, intracranial pressure increases, resulting in signs such as decorticate (flexor) or decerebrate (extensor) posturing, asymmetric or bilaterally dilated pupils, and Cushing’s triad (hypertension, bradycardia, abnormal respiratory pattern).

Question 39

A 56-year-old man has had chest pain for the past 2 days, but refused to go to the hospital. His wife called EMS when she noticed that he was not acting right. He is conscious, but confused, and is diaphoretic. His BP is 80/40 mm Hg and his pulse is rapid and weak. The patient’s history and your assessment findings are MOST consistent with:

A) acute ischemic stroke.
B) unstable angina pectoris.
C) cardiogenic hypoperfusion.
D) acute myocardial infarction.

Answer 39

Answer: C

The patient most likely experienced an acute myocardial infarction (AMI); however, since he did not receive timely treatment, extensive myocardial damage has resulted in pump failure. His low BP; weak, rapid pulses; and altered mental status indicate that he is systemically hypoperfused. Hypoperfusion (shock) secondary to a cardiac etiology (ie, pump failure, fast or slow heart rate) is called cardiogenic shock. True cardiogenic shock, which occurs when the myocardium is extensively and permanently damaged and can no longer meet the metabolic needs of the body, has a high mortality rate.

Question 40

A drug that possesses positive inotropic properties:

A) decreases the heart rate.
B) increases electrical conduction.
C) increases the heart rate.
D) increases cardiac contractility.

Answer 40

Answer: D

The term inotropy refers to the contractile state of the heart. If a drug possesses positive inotropic properties, it causes an increase in cardiac contractility. By contrast, a drug that possesses negative inotropic properties causes a decrease in cardiac contractility. Chronotropy refers to the heart rate; a positive chronotropic drug increases the heart rate, whereas a negative chronotropic drug decreases the heart rate. Dromotropy refers to the speed of electrical conduction through the heart. A positive dromotropic drug increases electrical conduction speed in the heart, whereas a negative dromotropic drug decreases electrical conduction speed in the heart.

Question 41

Immediately after establishing return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest, the AEMT should:

A) obtain the patient’s blood pressure.
B) mildly hyperventilate the patient.
C) reassess the patient’s breathing status.
D) start an IV line and give a normal saline bolus.

Answer 41

Answer: C

Immediately after establishing ROSC, the AEMT should reassess the patient’s breathing status. If the patient is breathing adequately, apply high-flow oxygen by nonrebreathing mask. If the patient is not breathing or is breathing inadequately (agonal gasps), continue to deliver positive-pressure ventilation. Hyperventilation should be avoided in any patient because it may hyperinflate the lungs, impair venous return to the heart (preload), and cause a drop in cardiac output. After reassessing the patient’s breathing, a complete set of vital signs should be obtained. If the patient is hypotensive (systolic BP

Question 42

Which of the following statements MOST accurately describes the pathophysiology of angina pectoris?

A) Reversible myocardial ischemia caused by partial coronary artery occlusion
B) Irreversible myocardial ischemia caused by complete coronary artery occlusion
C) Reversible myocardial necrosis caused by partial coronary artery occlusion
D) Irreversible myocardial necrosis caused by complete coronary artery occlusion

Answer 42

Answer: A

Angina pectoris is a reversible condition in which the myocardium becomes ischemic (it is relatively deprived of oxygen) because of partial occlusion of a coronary artery. It occurs when the heart’s demand for oxygen exceeds its available supply, such as what occurs during exertion, resulting in chest pain or discomfort. When oxygen supply and demand are rebalanced (the patient ceases exertion or takes nitroglycerin), the chest pain or discomfort subsides. Myocardial necrosis occurs when a coronary artery is completely blocked and the tissues and cells distal to the site of the occlusion die. Necrosis is not a reversible process.

Question 43

You and two other AEMTs are attempting to resuscitate a cardiac arrest patient en route to the hospital. One of your partners is experiencing difficulty establishing IV access and your other partner is unable to maintain an effective mask-to-face seal during ventilations. You should:

A) ask your driver to stop and pull over so you can establish IV access.
B) instruct your first partner to attempt to establish intraosseous access.
C) stop chest compressions briefly so you can insert a multilumen airway.
D) insert a King LT or CobraPLA without interrupting chest compressions.

Answer 43

Answer: D

As an AEMT, you are generally not authorized to administer cardiac medications (ie, epinephrine 1:10,000, amiodarone, lidocaine); therefore intravenous or intraosseous access should not be an immediate priority. The patient’s airway must be maintained and adequate ventilation and oxygenation must be established. If you are experiencing difficulty ventilating a patient with a bag-mask device, you should insert a supraglottic airway device (King LT or CobraPLA) or a Combitube. DO NOT interrupt chest compressions to do this. Stopping the ambulance is a waste of time and will do nothing more than delay arrival at the hospital.

Question 44

Chest pain of cardiac origin is commonly described by the patient as:

A) sharp.
B) stabbing.
C) crushing.
D) cramping.

Answer 44

Answer: C

Chest pain of cardiac origin typically is described as crushing, dull pressure, or a feeling of heaviness. Stabbing or sharp chest pain is more commonly associated with such conditions as spontaneous pneumothorax, pulmonary embolism, and aortic dissection.

Question 45

Which of the following is the MOST appropriate question to ask when inquiring about a patient’s chest pain?

A) Is the pain sharp or dull?
B) Can you describe the pain?
C) Does the pain radiate to your jaw?
D) Is the pain in the center of your chest?

Answer 45

Answer: B

When questioning patients about any type of pain, you should use open-ended questions whenever possible. This allows the patient to describe the pain in his or her own words. Closed-ended questions give the patient the option of simply answering yes or no and may not truly reflect what he or she is experiencing.

Question 46

Blood returns to the right atrium by the:

A) carotid artery.
B) coronary sinus.
C) circumflex artery.
D) pulmonary veins.

Answer 46

Answer: B

Three vessels return blood to the right atrium: the superior vena cava, the inferior vena cava, and the coronary sinus. The coronary sinus returns deoxygenated blood directly from the heart. The carotid arteries branch from the aorta and deliver oxygenated blood to the brain. The left main coronary artery divides into two major branches: the left anterior descending and the circumflex. These arteries supply oxygenated blood to the left side of the heart. The pulmonary veins carry oxygenated blood from the lungs to the left atrium.

Question 47

During treatment of a 60-year-old man in cardiac arrest, you delivered three shocks with the AED, performed high-quality CPR, and inserted a King LT airway before establishing return of spontaneous circulation. Which of the following interventions is included in the integrated postarrest care of this patient?

A) Removal of the King LT airway
B) Correction of hypoglycemia, if present
C) Keeping the patient warm with blankets
D) Removing the AED pads from the patient

Answer 47

Answer: B

If return of spontaneous circulation (ROSC) occurs after cardiac arrest, you should move to the integrated postarrest care phase, which is the fifth link in the chain of survival. Interventions performed during this phase include controlling body temperature (induced hypothermia) to optimize neurologic recovery; maintaining blood glucose levels if the patient is hypoglycemic; and further cardiopulmonary and neurologic support at the hospital. Removal of any advanced airway device is generally contraindicated in the field unless the patient is unreasonably intolerant of the device. Furthermore, the patient may still require ventilatory support, even after a pulse has returned. The AED pads should remain applied to the patient’s chest; however, you should turn off the AED.

Question 48

Which of the following describes Starling’s law?

A) decrease in systolic BP and an increase in diastolic BP
B) The amount of resistance the left ventricle must pump against
C) Progressive deterioration in cardiac muscle performance
D) Stretching of the ventricles as venous return to the heart is increased

Answer 48

Answer: D

Increased venous return to the heart (preload) stretches the ventricles to some extent, resulting in increased cardiac contractility. This process is called Starling’s law of the heart. According to Starling’s law, the more the cardiac muscle is stretched, the more forcefully it contracts. Pulse pressure is the difference between the systolic BP and the diastolic BP; a narrowing pulse pressure occurs when the systolic BP decreases and the diastolic BP increases. The amount of resistance that the left ventricle must pump against is called afterload. Progressive deterioration in cardiac muscle performance is called cardiomyopathy.

Question 49

A 30-year-old man complains of nausea and a mild headache. He is conscious and alert and denies chest pain or shortness of breath. His blood pressure is 136/68 mm Hg, his pulse is 46 beats/min and regular, and his respirations are 14 breaths/min and unlabored. Further assessment reveals that his breath sounds are clear and equal bilaterally and his oxygen saturation is 94% on room air. You should:

A) recognize that his heart rate must be urgently increased.
B) give high-flow oxygen, start a large-bore IV line, and transport.
C) request a paramedic unit because the patient needs an ECG.
D) give him oxygen as needed and transport him to the hospital.

Answer 49

Answer: D

The patient in this scenario is stable. Although he is bradycardic, which could be normal for him, he is experiencing no serious signs or symptoms (ie, chest pain, dyspnea, pulmonary edema) and the rest of his vital signs are stable. Simply provide supportive care, administer oxygen as needed to maintain his SpO2 greater than 94%, and transport him to the hospital. His heart rate does not need to be urgently increased because he is hemodynamically stable. There is also no immediate need to obtain an electrocardiogram (ECG), although the physician in the emergency department may elect to obtain one.

Question 50

Which of the following signs or symptoms is MOST indicative of right-sided heart failure?

A) Orthopnea
B) Pulmonary edema
C) Nocturnal dyspnea
D) Jugular vein distention

Answer 50

Answer: D

When the right side of the heart fails, blood is not effectively ejected by the right ventricle; therefore, it backs up into the systemic circulation. Clinically, this manifests as jugular venous distention. Other signs of right-sided heart failure include peripheral edema and ascites (fluid accumulation in the peritoneum). In contrast to right-sided heart failure, left-sided heart failure can impair ventilation and oxygenation. Signs of left-sided heart failure include orthopnea (positional dyspnea); nocturnal dyspnea (awakening in the middle of the night with a feeling of being smothered); and pulmonary edema (fluid in the lungs).

Question 51

Cardiac afterload is greater with:

A) vasodilation.
B) tachycardia.
C) decreased preload.
D) vasoconstriction.

Answer 51

Answer: D

The amount of pressure against which the left ventricle must contract is called the afterload. The greater the afterload, the harder it is for the left ventricle to eject blood into the aorta. Preload is the amount of blood returned to the heart. To a large degree, afterload is governed by arterial blood pressure. Afterload is greater with vasoconstriction and less with vasodilation. If systemic vascular resistance is increased (the blood vessels are constricted), the left ventricle must work harder to pump the same volume of blood through a smaller container. Bradycardia and tachycardia directly affect cardiac output, not afterload.

Question 52

A 66-year-old man with chest discomfort tells you that he takes lisinopril for hypertension. Which of the following questions would be MOST important for you to ask him regarding his medication?

A) Where did you obtain the medication?
B) When were you first prescribed the medication?
C) Have you been taking your medication as prescribed?
D) When was the last time that you took your medication?

Answer 52

Answer: C

Asking a patient if he or she has taken his or her medication as prescribed helps determine overall medication compliance and is a very important aspect of the SAMPLE history. Simply asking the patient when he or she last took the medication does not allow you to determine overall compliance. Where the patient obtained his medication and when it was first prescribed for him are of lesser pertinence.

Question 53

Nitroglycerin is given to patients with suspected cardiac chest pain because of its physiologic effects of smooth muscle:

A) relaxation and decreased preload.
B) relaxation and increased preload.
C) contraction and increased afterload.
D) contraction and decreased preloa

Answer 53

Answer: A

Nitroglycerin relaxes the smooth muscle of the blood vessels. When given to a patient with cardiac-related chest pain, it dilates the coronary arteries, which increases oxygen supply to the myocardium. It also promotes systemic pooling of blood through vasodilation and decreases preload (the amount of blood returned to the heart). This effect decreases the workload on the myocardium.

Question 54

Which of the following questions would be the MOST appropriate to ask when assessing a patient with nontraumatic chest pain, pressure, or discomfort?

A) Is this the worst pain of your life?
B) Does the pain move to your arms?
C) Is the pain crushing or dull in nature?
D) Can you describe how the pain feels?

Answer 54

Answer: D

You should use simple questioning techniques and ask open-ended questions when assessing any patient with any kind of pain. Instead of asking the patient if his or her pain is sharp or dull, simply ask him or her to describe the pain in his or her own words. This allows you to obtain the most accurate information regarding what the patient is really feeling. Closed-ended questions (those that can be answered with yes or no) should be avoided whenever possible. The answers to closed-ended questions often yield unreliable information.

Question 55

Stroke volume can be increased by:

A) decreasing the heart rate.
B) increasing preload.
C) increasing afterload.
D) decreasing the blood volume.

Answer 55

Answer: B

Stroke volume is the amount of blood ejected from the left ventricle per contraction. An increase in the amount of blood that returns to the heart (preload) causes the cardiac muscle to stretch, thus making it contract more forcefully; as a result, stroke volume increases (Starling’s law). If the amount of resistance against which the left ventricle contracts (afterload) increases, it is harder for the ventricle to eject blood into the aorta; as a result, stroke volume decreases. If blood volume decreases, there is less blood to eject from the heart; as a result, stroke volume naturally decreases. Cardiac output is affected by stroke volume, heart rate, or both. If the heart rate decreases, stroke volume remains the same, but cardiac output decreases because of fewer contractions per minute.

Question 56

Which of the following statements regarding ventricular fibrillation is correct?

A) V-Fib is the least common rhythm observed in adult sudden cardiac arrest
B) In V-Fib, the heart is not pumping any blood at all and the patient is pulseless
C) V-Fib is characterized by weak central pulses and a diminished cardiac output
D) Defibrillation should only be attempted one time for patients with V-Fib

Answer 56

Answer: B

Ventricular fibrillation (V-Fib) is a chaotic, quivering of the heart muscle that occurs when the cardiac cells depolarize in an uncontrolled fashion. As a result, no blood is pumped from the heart and the patient is pulseless. V-Fib is the most common initial rhythm seen in adult patients with sudden cardiac arrest. Defibrillation is indicated after every 2 minutes of CPR if V-Fib persists; it is not attempted only “one time.” For each minute that V-Fib persists, the patient’s chance of survival decreases by as much as 10%.

Question 57

In which position should an uninjured patient be in during your assessment of the jugular veins?

A) Supine
B) Semi-Fowler
C) Shock position
D) Lateral recumbent

Answer 57

Answer: B

Unless a patient is injured and must be in a supine position, the jugular veins should be assessed for distention while the patient is sitting at a 45-degree angle (semi-Fowler position). When the patient is supine (lying flat on the back) or in the shock position (supine with the lower extremities elevated 6 to 12 inches), blood return to the heart often causes the jugular veins to naturally distend. In a semi-Fowler position, however, the jugular veins should not be distended; the presence of JVD in a semi-Fowler position may indicate increased systemic venous pressure, such as what is caused by right heart failure.

Question 58

Which of the following would MOST likely occur if the sinoatrial (SA) node ceased functioning?

A) pacemaker in the left atrium would assume the heart’s pacing function at the same rate as the SA node
B) The ventricles would assume the heart’s pacing function, but at a rate of between 20 and 40 per minute
C) The atrioventricular node would assume the heart’s pacing function, but at a rate of 40 to 60 per minute
D) All pacemakers distal to the SA node would cease to function and the patient would develop asystole

Answer 58

Answer: C

The cardiac conduction system is comprised of a primary, secondary, and tertiary pacemaker. The dominant pacemaker in otherwise healthy patients is the sinoatrial (SA) node, which is located high in the right atrium. The SA node has an intrinsic pacing rate of 60 to 100 per minute. If the SA node ceased functioning, the atrioventricular (AV) node would likely assume the heart’s pacing function; however, the rate would be slower (between 40 and 60 per minute). If the SA and AV nodes ceased to function, a ventricular pacemaker would likely assume the pacing function of the heart; however, the rate would be even slower (between 20 and 40 per minute).

Question 59

A paramedic administers a drug that possesses positive inotropic properties. This drug is being given to:

A) increase cardiac contractility.
B) decrease the blood pressure.
C) reduce cardiac ejection fraction.
D) increase cardiac conduction speed.

Answer 59

Answer: A

Many of the medications given to patients in emergency medicine have various effects on the heart. Inotropy refers to the contractile state of the heart; therefore, a positive inotropic drug increases cardiac contractility, whereas a negative inotropic drug decreases contractility and also decreases the blood pressure and ejection fraction (the percentage of blood pumped from the left ventricle per beat). Chronotropy refers to the heart rate; therefore, a positive chronotropic drug increases the heart rate and a negative chronotropic drug decreases the heart rate. Dromotropy refers to electrical conduction speed through the heart; therefore, a positive dromotropic drug increases electrical conduction speed and a negative dromotropic drug decreases electrical conduction speed.

Question 60

What is the pathophysiology of Prinzmetal angina?

A) Cardiac tissue necrosis
B) Coronary artery spasm
C) Atherosclerotic blockage
D) Cardiac muscle deterioration

Answer 60

Answer: B

Prinzmetal angina, also referred to as vasospastic or variant angina, occurs when a coronary artery suddenly spasms. It is much less common than angina that occurs from atherosclerotic coronary artery disease, in which case a coronary artery is partially occluded by plaque. Progressive cardiac muscle deterioration results in a condition called cardiomyopathy. Angina, regardless of the type, is associated with ischemia (a relative deprivation of oxygen). Cardiac tissue death (necrosis) occurs during acute myocardial infarction.