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Emergency Medical Technician > Cardiovascular Emergencies - Basics & Pathophysiology > Flashcards

Cardiovascular Emergencies - Basics & Pathophysiology Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Normal electrical impulses in the heart begin in the ___

A

Sinus node

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2
Q

Where is the sinus node?

A

Upper right part of the right atrium

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3
Q

What is the sinus node also known as?

A

Sinoatrial node (SA)

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4
Q

From the SA node, the electrical impulses ___

A

Travel across both atria, causing them to contract

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5
Q

Between the atria and the ventricles, the impulses ___

A

Cross a bridge of special electrical tissue

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6
Q

Special electrical tissue that bridge the atria and ventricles

A

Atrioventricular node (AV)

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7
Q

What happens to the electrical impulse at the AV node?

A

It is slowed for about one to two-tenths of a second to allow blood time to pass from the atria to the ventricles

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8
Q

After the impulses exit the AV node they ___

A

Spread throughout both ventricles via the bundle of His, the right and left bundle branches, and the Purkinje fibers, ultimately causing the muscle cells of the ventricles to contract

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9
Q

Special characteristic of cardiac muscles cells not found in any other type of muscle cells

A

Automaticity

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10
Q

Allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source

A

Automaticity

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11
Q

If no impulse arrives, the other myocardial cells are capable of ___

A

Creating their own impulses and stimulating a contraction of the heart, although at a generally slower rate

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12
Q

The stimulus that originates in the SA node is controlled by ___

A

Impulses from the brain, which arrive by way of the autonomic nervous system

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13
Q

___ nervous system speeds up the heart, and the ___ nervous system slows it down

A
  1. Sympathetic
  2. Parasympathetic
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14
Q

How does the heart supply itself with more oxygen and nutrients during times of exertion?

A

Dilation of the coronary arteries

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15
Q

The coronary arteries start at ___

A

The first part of the aorta, just above the aortic valve

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16
Q

The right coronary artery supplies blood to the ___

A

Right atrium and right ventricle, and in most people, the inferior wall of the left ventricle

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17
Q

The left coronary artery supplies blood to the ___

A

Left atrium and left ventricle and divides into two major branches, just a short distance from the aorta

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18
Q

___ supply the head and brain with blood

A

Left and right carotid arteries

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19
Q

___ supply blood to the upper extremities

A

Left and right subclavian arteries

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20
Q

As the subclavian artery enters each arm, it becomes the ___

A

Brachial artery

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21
Q

Just below the elbow, the brachial artery ___

A

Divides into two major branches: the radial and ulnar arteries

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22
Q

Two major arteries branching from the ___ supply blood to the head and arms

A

Upper aorta

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23
Q

At the level of the umbilicus, the descending aorta ___

A

Divides into two main branches called the right and left iliac arteries

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24
Q

The iliac arteries supply blood to the ___

A

Groin, pelvis, and legs

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25
Q

As the iliac arteries enter the legs through the groin, they ___

A

Become the right and left femoral arteries

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26
Q

At the level of the knee, the femoral artery ___

A

Divides into the anterior and posterior tibial arteries and the perineal artery, supplying blood to the lower legs and feet

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27
Q

After blood travels through the arteries, it enters ___

A

Arterioles

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28
Q

Smallest branches of veins

A

Venules

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29
Q

Carries blood from the head and arms back to the right atrium

A

Superior vena cava

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30
Q

Carries blood from the abdomen, pelvis, and legs back to the right atrium

A

Inferior vena cava

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31
Q

The superior and inferior venae cavae join at the ___

A

Right atrium

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32
Q

The MAP is a good measure of ___

A

Perfusion

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33
Q

Three primary components of perfusion

A
  1. Well-functioning heart
  2. Adequate volume of blood
  3. Blood vessels must be properly constricted
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34
Q

Chest pain or discomfort that is related to the heart usually stems from a condition called ___

A

Ischemia

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35
Q

Decreased blood flow

A

Ischemia

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36
Q

Disease involving a decrease in blood flow to one or more portions of the heart muscle

A

Ischemic heart disease

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37
Q

Most often, low blood flow to heart tissue is caused by ___

A

Coronary artery atherosclerosis

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38
Q

A disorder in which calcium and fatty material called cholesterol build up and form a plaque inside the walls of blood vessels, obstructing flow and interfering with their ability to dilate or contract

A

Atherosclerosis

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39
Q

Eventually, atherosclerosis can cause ___

A

Complete occlusion of a coronary artery

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40
Q

Inside diameter of the artery

A

Lumen

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41
Q

The inner wall of the artery becomes ___ with atherosclerotic plaques

A

Rough and brittle

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42
Q

A blood clot that is floating though blood vessels until it reaches an area too narrow for it to pass, stopping and blocking blood flow at that point

A

Thromboembolism

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43
Q

If a blockage occurs in a coronary artery, a ___ will result

A

Acute myocardial infarction (AMI)

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44
Q

AMI

A

Acute myocardial infarction

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45
Q

Acute myocardial infarction

A

Heart attack

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46
Q

Death of tissue

A

Infarction

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47
Q

Heart stops pumping completely

A

Cardiac arrest

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48
Q

Major controllable risk factors for an AMI

A
  1. Cigarette smoking
  2. High BP
  3. Elevated cholesterol level
  4. Elevated blood glucose level
  5. Lack of exercise
  6. Obesity
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49
Q

Major risk factors of AMI that cannot be controlled

A
  1. Older age
  2. Family history of atherosclerotic coronary artery disease
  3. Race
  4. Ethnicity
  5. Male sex
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50
Q

Other lifestyle risk factors for AMI

A
  1. Stress
  2. Excessive alcohol
  3. Poor diet
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51
Q

A term used to describe a group of symptoms caused by myocardial ischemia

A

Acute coronary syndrome (ACS)

52
Q

ACS

A

Acute coronary syndrome

53
Q

Temporary reduced blood flow to the heart

A

Angina pectoris

54
Q

Angina pectoris is treated like ___

A

ACS

55
Q

What causes angina?

A

Can be the result of a spasm of an artery, but usually its a symptom of atherosclerotic coronary artery disease

56
Q

Angina occurs when ___

A

The heart’s need for oxygen exceeds its supply, usually during periods of physical or emotional stress when the heart is working hard

57
Q

Anginal pain is commonly described as ___

A

Crushing, squeezing, or “like somebody standing on my chest”, felt in the mid portion of the chest, under the sternum

58
Q

Angina can radiate to ___

A

The jaw, the arms (frequently the left arm), the mid portion of the back, or the epigastrium

59
Q

Upper-middle region of the abdomen

A

Epigastrium

60
Q

Angina pain lasts ___

A

Usually 3 to 8 minutes, rarely longer than 15 minutes

61
Q

Angina may be associated with ___

A

Shortness of breath, nausea, or sweating

62
Q

Angina will usually disappear with ___

A

Rest, supplemental oxygen, and nitroglycerin

63
Q

With angina, the electrical system ___

A

Can be compromised due to the diminished oxygen supply and put the person at risk for problems with cardiac rhythm

64
Q

Angina that is characterized by pain or discomfort in the chest of coronary origin that occurs in the absence of a significant increase in myocardial oxygen demand

A

Unstable angina

65
Q

Untreated unstable angina is associated with a ___

A

Very high risk of spontaneous AMI

66
Q

Angina that is characterized by pain in the chest of coronary origin that occurs in response to exercise or some activity that increases the demand on the heart muscle beyond the heart’s capacity to increase its own blood flow

A

Stable angina

67
Q

Heart muscle cells begin to die about ___ after blood flow is cut off

A

30 minutes

68
Q

After about ___, as many as one half of the cells in the heart can be dead

A

2 hours

69
Q

In most cases, after 4 to 6 hours, more than ___ of the heart cells will be dead

A

90%

70
Q

How AMI is fixed

A

Opening the coronary artery with thrombolytic medications of angioplasty can prevent permanent damage if done within the first few hours after the onset of symptoms

71
Q

Angioplasty

A

Mechanical clearing of the artery

72
Q

Thrombolytic

A

Clot-busting

73
Q

An AMI is most likely to occur in ___

A

The larger, thick-walled left ventricle

74
Q

Why is an AMI most likely to occur in the left ventricle?

A

More blood and oxygen demand than the right ventricle

75
Q

Signs and symptoms of AMI

A
  1. Sudden onset of weakness, nausea, and sweating without obvious cause
  2. Chest pain, discomfort, or pressure that is often crushing, squeezing and that does not change with each breath
  3. Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck
  4. Irregular heartbeat and syncope
  5. Shortness of breath or dyspnea
  6. Nausea/vomiting
  7. Pink, frothy sputum (indicating possible pulmonary edema)
  8. Sudden death
76
Q

Three ways pain from an AMI is different from the pain of angina

A
  1. It may or may not be caused by exertion, but can occur at any time, sometimes when a person is sitting quietly or sleeping
  2. It does not resolve in a few minutes, can last between 30 minutes to several hours
  3. It may or may not be relieved by rest or nitroglycerin
77
Q

___, may not experience pain during any AMI, but ay have other common complaints associated with ischemia

A

Older patients, women, and those with diabetes

78
Q

It is not uncommon for the only complaint with an AMI, especially in older patients and women, to be ___

A

Fatigue

79
Q

AMI without the chest pain

A

Silent myocardial infarction

80
Q

Physical findings of AMI (general appearance)

A
  1. Often appears frightened
  2. May be nausea, vomiting, and a cold sweat
  3. Skin is often pale or ashen gray
  4. Occasionally cyanosis
81
Q

Physical findings of AMI (pulse)

A
  1. Generally rate increases
  2. Dysrhythmias are common
  3. May feel an irregularity or even slowing of the pulse
82
Q

Damage to the inferior area of the heart often presents with ___

A

Bradycardia

83
Q

Physical findings of AMI (BP)

A
  1. May fall
  2. Most will have a normal or even elevated BP
84
Q

Physical findings of AMI (respiration)

A
  1. Usually normal unless the patient has CHF, in which case respirations may become rapid and labored with a higher chance of cyanosis and possibly frothy sputum
  2. Difficulty breathing is common even with a normal rate
85
Q

Physical findings of AMI (mental status)

A
  1. Often experience confusion or agitation and sometimes experience an almost overwhelming feeling of impending doom
86
Q

Three serious consequences of an AMI

A
  1. Sudden death
  2. Cardiogenic shock
  3. Congestive heart failure
87
Q

Heart is twitching erratically, using energy without pumping any blood

A

Ventricular dysrhythmia, known as ventricular fibrillation (VF)

88
Q

Most common dysrhythmias after AMI

A

Premature ventricular contractions, or extra beats in the damaged ventricle

89
Q

Rapid beating of the heart, 100 BPM or more

A

Tachycardia

90
Q

Unusually slow beating of the heart, 60 BPM or less

A

Bradycardia

91
Q

Rapid heart rhythm, usually at a rate of 150 - 200 BPM. The electrical signal starts in the ventricle instead of the atrium

A

Ventricular tachycardia (VT)

92
Q

Effect of VT

A

The rhythm does not allow time between beats for the left ventricle to fill with blood. The heart pumps less volume and BP may fall, or the pulse may be lost altogether

93
Q

Disorganized, ineffective quivering of the ventricles

A

Ventricular fibrillation (VF)

94
Q

Effect of VF

A

No blood is pumped and the patient becomes unconscious within seconds

95
Q

To shock the heart with a specialized electrical current in an attempt to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore normal rhythmic beat

A

Defibrillate

96
Q

Chances of survival after cardiac arrest while CPR is being completed before application of the AED

A

Diminishes 7% to 10% each minute

97
Q

If uncorrected, unstable VT or VF will eventually lead to ___

A

Asystole

98
Q

The absence of all heart electrical activity

A

Asystole

99
Q

Without CPR, systole may occur within ___

A

Minutes

100
Q

Systole usually reflects a long period of ___

A

Ischemia

101
Q

Cardiogenic shock is more commonly found after an AMI that affects the ___

A

Inferior and posterior regions of the left ventricle

102
Q

Failure of the heart occurs when ___

A

Then ventricular myocardium is so profoundly damaged that it can no longer keep up with the return flow of blood from the atria

103
Q

CHF

A

Congestive heart failure

104
Q

CHF can occur at any time after a ____

A

Myocardial infarction

105
Q

Treatment of cardiogenic shock

A
  1. Position comfortably
  2. Administer oxygen at a rate to keep oxygen saturation at 95% to 99%
  3. Assist ventilations as necessary
  4. Cover with blankets to preserve body heat
  5. Prompt transport to ED
106
Q

Treatment of CHF

A
  1. Take vital signs and give oxygen by CPAP
  2. Allow to sit upright with legs down
  3. Reassure
  4. Gather medications
  5. Give nitroglycerin if the systolic BP is greater than 100 mm/Hg
  6. Prompt transport to ED
107
Q

With left-sided heart failure, the lungs become ___

A

Congested with fluid

108
Q

If the right side of the heart is damaged, fluid ___

A

Collects in the body, often showing up as swelling in the feet and legs

109
Q

The collection of fluid in the part of the body that is closest to the ground

A

Dependent edema

110
Q

Chronic dependent edema may indicate ___ even in the absence of pain or other symptoms

A

Underlying heart disease

111
Q

Any systolic BP greater than 130 mm/HG or diastolic BP greater than 80 mm/Hg

A

Hypertension

112
Q

A systolic pressure greater than 180 mm/Hg in the presence of impending or progressive organ damage

A

Hypertensive emergency

113
Q

Most common sign of a hypertensive emergency

A

Severe headache

114
Q

Signs and symptoms of hypertensive emergency

A
  1. Severe headache
  2. Strong bounding pulse
  3. Ringing in the ears
  4. Nausea
  5. Vomiting
  6. Dizziness
  7. Warm skin (dry or moist)
  8. Nosebleed
  9. Altered mental status
  10. Sudden development of pulmonary edema
115
Q

Untreated hypertensive emergencies can lead to ___

A

A stroke or a dissecting aortic aneurysm

116
Q

Treatment of hypertensive emergencies

A
  1. Make comfortable
  2. Monitor BP
  3. Keep head elevated
  4. Transport to ED
  5. Consider ALS support
117
Q

Weakness in the wall of the aorta. The aorta dilates at the weakened area, making it susceptible to rupture

A

Aortic aneurysm

118
Q

Occurs when the inner layers of the aorta become separated, allowing blood at high pressures to flow between the layers

A

Dissecting aneurysm

119
Q

Primary cause of dissecting aortic aneurysms

A

Uncontrolled hypertension

120
Q

AMI vs Dissecting aneurysm onset of pain

A

AMI: Gradual, with additional symptoms
DA: Abrupt, without additional symptoms

121
Q

AMI vs Dissecting aneurysm quality of pain

A

AMI: Tightness or pressure
DA: Sharp or tearing

122
Q

AMI vs Dissecting aneurysm severity of pain

A

AMI: Increases with time
DA: Maximal from onset

123
Q

AMI vs Dissecting aneurysm timing of pain

A

AMI: May wax and wane
DA: Does not abate once it has started

124
Q

AMI vs Dissecting aneurysm region/radiation

A

AMI: Substernal; back is rarely involved
DA: Back possibly involved, between the shoulder blades

125
Q

AMI vs Dissecting aneurysm clinical signs

A

AMI: Peripheral pulses equal
DA: BP discrepancy between arms or decrease in a femoral or carotid pulse

Emergency Medical Technician (100 decks)

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