Chapter 20 | Cardiac Emergencies Flashcards
• Aspects of acute coronary syndrome (ACS) • Conditions that may lead to a cardiac emergency
1
Q
Define:
cardiac conduction system
A
system of specialized muscle tissue that conducts electrical impulses that stimulate the heart to the beat
2
Q
Locate and define:
coronary arteries
A
major blood vessels which supply blood to the heart
3
Q
Define:
artery
A
blood vessels carrying oxygenated blood from heart to body
4
Q
Define:
vein
A
blood vessels carrying deoxygenated blood from body to heart
5
Q
Locate and define:
vena cava
A
major blood vein carrying deoxygenated blood from body to heart
6
Q
Locate and define:
aorta
A
main artery of body carrying oxygenated blood from heart to body
7
Q
Locate and define:
pulmonary arteries
A
vessels which transport deoxygenated blood from heart to lungs (for oxygenation)
8
Q
Locate and define:
pulmonary veins
A
blood vessels that carry oxygenated blood from lungs to heart
9
Q
Define:
acute coronary syndrome (ACS)
(AKA “cardiac compromise”)
A
any time the heart may not be getting enough oxygen
10
Q
Define:
ACS
(abbreviation)
A
acute coronary syndrome
11
Q
List:
signs/symptoms of ACS
6 points (patient complaints and body response)
A
- chest pain (angina pectoris)
- dyspnea (shortness of breath)
- nausea or abdominal pain/discomfort
- sweating
- tachycardia (high HR)
- hypertension (high BP)
(ACS is acute coronary syndrome)
12
Q
List:
patients who may have atypical presentation of ACS
3 points
A
- women
- diabetics
- elderly
13
Q
Define:
EKG
(abbreviation)
A
electrocardiogram
(yeah the K is dumb)
14
Q
Define:
electrocardiogram (EKG)
A
recording of heart’s electrical signal to check for abnormal heart conditions
15
Q
Locate and define:
pulmonary valve
A
valve between between the heart’s right ventricle and pulmonary artery
16
Q
Locate and define:
aortic valve
A
valve between the heart’s left ventricle and aorta
17
Q
Some patients, such as [BLANK], [BLANK], and [BLANK], may experience atypical symptoms of ACS.
A
such as women, diabetics, and elderly
18
Q
Define:
STEMI
(abbreviation)
A
ST segment elevation myocardial infarction
worst kind of heart attack
19
Q
Define:
STEMI
(what it is)
A
when an artery supplying blood to the heart muscle suddenly becomes partially or completely blocked by a blood clot
(most serious type of heart attack)
20
Q
List:
treatments for ACS
5 points
A
- position of comfort
- supplemental oxygen
- aspirin
- nitroglycerin
- rapid transport (to cardiac center)
21
Q
Define:
coronary artery disease
A
conditions that narrow/block arteries of heart and deprive heart muscles (myocardium) of oxygen
22
Q
Fill in the blank:
Coronary artery disease is often a result of [BLANK] on the inner walls of arteries.
(pathophysiology)
A
Coronary artery disease is often a result of fatty deposit build-up on the inner walls of arteries.
23
Q
Define:
thrombus
A
blood clot on the inner surface of artery
24
Q
Define:
embolus
A
flowing piece of blood clot that breaks loose and flows to smaller artery
25
# Define:
occlusion
blockage of blood vessel
| (causes emergency in majority of cardiac-related medical emergencies)
26
# Define:
aneurysm
weakened section of blood vessels which begin to dilate (baloon)
| (rupture can cause rapid, life-threatening internal bleeding)
27
# List:
mechanical malfunctions of the heart
| 3 points
* angina pectoris
* acute myocadial infarction (AMI)
* congestive heart failure (CHF)
28
# Define:
angina pectoris
*temporary* chest pain caused by insufficient blood flow to the myocardium
29
# Fill in the blank:
Angina pectoris is typically caused by **[BLANK]**.
Angina pectoris is typically caused by **narrowed arteries**.
| so myocardium doesn’t get enough oxygen
30
# Define:
AMI
| (abbreviation)
**a**cute **m**yocardial **i**nfarction
31
# Define:
myocardial infarction (MI)
death of a portion of myocardium due to lack of oxygen
| (coronary artery is completely blocked)
32
# Fill in the blank:
The underlying cause of AMI is typically **[BLANK]**.
The underlying cause of AMI is typically **coronary artery disease**.
| (AMI is **a**cute **m**yocardial **i**nfarction)
## Footnote:
the myocardium is deprived of oxygen with coronary artery occlusion
prolonged deprivation of oxygen supply to the myocardium can lead to myocardial cell death and necrosis
33
# Fill in the blank:
*CHF* often leads to **[BLANK]**.
CHF often leads to **excessive fluid build-up in the lungs or body (pulmonary edema)**.
| (CHF is **c**ongestive **h**eart **f**ailure)
34
# List:
underlying *conditions that increase risk* of **CHF**
| 3 points
* diseased heart valves
* chronic hypertension
* obstructive pulmonary disease
| heart not working right, too much pressure going in, or blockage on the way out
35
# Fill in the blank:
*CHF* is often a complication of **[BLANK]**.
*CHF* is often a complication of **AMI**.
## Footnote
CHF is **c**ongestive **h**eart **f**ailure
AMI is **a**cute **m**yocardial **i**nfarction
36
# Fill in the blank:
**[BLANK]** is often a complication of *AMI*.
**CHF** is often a complication of *AMI*.
## Footnote
CHF is **c**ongestive **h**eart **f**ailure
AMI is **a**cute **m**yocardial **i**nfarction
37
# List:
stages in *progression* of **CHF**
| 4 points
1. patient sustains **AMI**
2. myocardium of **left ventricle dies**
3. **blood backs up** into pulmonary circulation and lungs
4. (if untreated) left heart failure commonly causes **right heart failure**
38
# True or false:
Angina pectoris is generally relieved by over-the-counter medications.
false
39
# True or false:
Angina pectoris can be brought on by exertion or stress.
true
40
# True or false:
Angina pectoris generally lasts 30 to 60 minutes.
false
| usually 5 minutes or less
41
# True or false:
Angina pectoris results in *death of a smaller portion* of myocardium than does a heart attack.
false
| stable angina shouldn’t *kill* myocardium at all
42
# Choose:
What is *not* a result of a mechanical malfunction of the heart?
## Footnote
**A:** Dysrhythmia
**B:** Cardiac arrest
**C:** Pulmonary edema
**D:** Cardiogenic shock
**A**
43
# Choose:
A weakened area of an artery that balloons out and may rupture, causing catastrophic bleeding, is called:
## Footnote
**A:** an aneurysm
**B:** angioplasty
**C:** angina
**D:** asystole
**A**
44
# Choose:
Which of the following *best* describes a fluttering sensation in the chest?
## Footnote
**A:** palpitations
**B:** pulseless electrical activity of the heart
**C:** dysrhythmia
**D:** tachycardia
**A**
45
# Answer:
Assuming your protocol allows the administration of nitroglycerin when certain conditions exist, what is the maximum number of tablets to be administered in the prehospital setting?
3 tablets
46
# Choose:
Blunt and penetrating injuries can damage chambers of the heart or cause conditions like:
## Footnote
**A:** ventricular tachycardia
**B:** pericardial tamponade
**C:** asphyxial cardiac arrest
**D:** ventricular fibrillation
**B**
47
# Fill in the blank:
Cardiac arrest in children is more likely to be due to **[BLANK]** than adults.
Cardiac arrest in children is more likely to be due to **respiratory failure** than adults.
48
# Choose:
In which of the following ways does cardiac arrest in children differ from cardiac arrest in adults?
## Footnote
**A:** Cardiac arrest in children is more likely to be due to respiratory failure.
**B:** Ventricular fibrillation is common in children.
**C:** Cardiac arrest in adults is more likely to be due to respiratory failure.
**D:** Ventricular fibrillation is not common in adults.
**A**
49
# Answer:
You are on the scene of a 68-year-old male patient complaining of severe chest pain for the last 20 minutes. He has a previous history of myocardial infarction and states it feels "just like the last time." You have applied oxygen and assisted him in administering aspirin and nitroglycerin with no reduction in the chest pain. Your nearest facility is 5 minutes away, a Level III Trauma Center is 10 minutes away, and a hospital with cardiac catheterization capabilities is 20 minutes away. The patient is requesting to be transported to his cardiologist's hospital, which is 30 minutes away.
**What type of hospital is the best destination?**
the nearest **hospital with *cardiac catheterization***
50
# Define:
pedal edema
accumulation of fluid in the feet or ankles
51
# Choose:
**C**
52
# Choose:
**A**
53
# Choose:
**C**
54
# Choose:
**C**
55
# Choose:
**B**
56
# Choose:
**C**
57
# Choose:
**C**
58
# Choose:
**C**
59
# Choose:
**B**
60
# Choose:
**C**
61
# Choose:
**C**
62
# Choose:
**C**
63
# Choose:
**A**
64
# Choose:
**C**
65
# Choose:
**C**
66
# Choose:
**D**
67
# Choose:
**B**
68
# Choose:
**C**
69
# Choose:
**B**
70
# Choose:
**B**
71
# Choose:
**C**
72
# Choose:
**B**
73
# Choose:
**A**
74
# Choose:
**B**
75
# Choose:
**B**
76
# Choose:
**D**
77
# Choose:
**A**
78
# Choose:
**B**
79
# Choose:
**A**
80
# Choose:
**D**
81
# Choose:
**C**
82
# Choose:
**C**
## Footnote:
LVAD acts as heart itself in making blood flow (not just replacing electrical impulses)
no pulse is present because blood flows continuously (rather than being pumped by beats)
83
# List:
4 valves of the heart
| (**T**oilet **P**aper **M**y **A**ss)
* **tricuspid** valve
* **pulmonary** valve
* **mitral** valve
* **aortic** valve
84
# List:
things that can stop heart from getting oxygen
| 3 points
* blockage (AMI/PE)
* lack of blood (aneurysm/shock)
* heart doing bad job (CHF/arrhythmias)
85
# List:
*risk factors* for **CAD**
| 3 points
* obesity
* cigarette smoking
* possible genetic causes
| (CAD is **c**oronary **a**rtery **d**isease)
86
# Fill in the blank:
*Angina pectoris* is **[PERMANENT/TEMPORARY]**.
*Angina pectoris* is **temporary**.
87
# Answer:
What is the *most important* treatment you can provide for an AMI?
aspirin
| (AMI is **a**cute **m**yocardial **i**nfarction)
88
# Fill in the blank:
*Unstable angina* is **[PERMANENT/TEMPORARY]**.
*Unstable angina* is **permanent**.
| doesn't go away with rest like angina should
89
# True or false:
Aspirin should not be used in children.
true
| (only for pain management *maybe*)
90
# Define:
Levine’s sign
a clenched fist held over the chest to describe ischemic chest pain
91
# Fill in the blank:
A clenched fist held over the chest to describe ischemic chest pain is known as **[BLANK]**.
A clenched fist held over the chest to describe ischemic chest pain is known as **Levine's sign**.
92
# Define:
MI
| (abbreviation)
**m**yocardial **i**nfarction
93
# Choose:
You are called to see a 78-year old man complaining of chest pain. His wife says this is the first time he's complained of this. Before pharmacological intervention, **what should you ask about?**
## Footnote
**A.** The need for any cholesterol medications
**B.** The use of erectile dysfunction medications
**C.** The need for any blood pressure medications
**D.** The need for any medications to treat asthma
**B**
## Footnote
*You should ask about his sex life, specifically, the need to take sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or other nitrates for ED. If given in conjunction with Nitro these medications can cause profound hypotension.*
94
# Choose:
Your 62-year-old patient is experiencing sub-sternal chest pain and has no known drug allergies. She has not taken any medications and her vital signs are: HR 92, BP 156/94, SPO2 98%, and RR 20.
**Which of the following is the *most appropriate* first medication for this patient?**
## Footnote
**A.** Aspirin 324 mg PR
**B.** Morphine 4 mg IV
**C.** Aspirin 324 mg PO
**D.** Nitroglycerin 0.3mg SL
**C**
## Footnote
*Given the presence of sub-sternal chest pain in an elderly patient, there should be a high suspicion for acute coronary syndrome (ACS). This indicates that the correct answer is aspirin 324mg PO (per oral). Time to aspirin administration is one of the most significant determinants of outcome in myocardial infarction and stroke. Both nitroglycerin and morphine are possibly indicated although more appropriate after aspirin. Aspirin PR (per rectum), while technically correct, is usually never carried on an ambulance in the correct form and is not as appropriate as the oral form.*
95
# Choose:
Emergency Medical Services (EMS) has been called for a middle-aged male who has recently stopped taking his medications following surgery; resulting in chest pain, diaphoresis, and a sense of impending doom. The paperwork from the hospital notes he had a 3-vessel coronary artery bypass graft (CABG).
**Which of the following conditions is *most likely* to be causing this patient's present symptoms?**
## Footnote
**A.** Coronary Artery Disease (CAD)
**B.** Myocardial Infarction (MI)
**C.** Pulmonary embolism (PE)
**D.** Peripheral Vascular Disease (PVD)
**B**
## Footnote
*A CABG (Coronary Artery Bypass Graft) is performed for severe CAD (coronary artery disease). If a patient doesn't take their medications following CABG they are at immense risk for an MI (myocardial infarction) as the bypass will clot off and remove blood flow to the heart tissue.*
