Chapter 20 | Cardiac Emergencies Flashcards
• Aspects of acute coronary syndrome (ACS) • Conditions that may lead to a cardiac emergency
Define:
cardiac conduction system
system of specialized muscle tissue that conducts electrical impulses that stimulate the heart to the beat
Locate and define:
coronary arteries
major blood vessels which supply blood to the heart
Define:
artery
blood vessels carrying oxygenated blood from heart to body
Define:
vein
blood vessels carrying deoxygenated blood from body to heart
Locate and define:
vena cava
major blood vein carrying deoxygenated blood from body to heart
Locate and define:
aorta
main artery of body carrying oxygenated blood from heart to body
Locate and define:
pulmonary arteries
vessels which transport deoxygenated blood from heart to lungs (for oxygenation)
Locate and define:
pulmonary veins
blood vessels that carry oxygenated blood from lungs to heart
Define:
acute coronary syndrome (ACS)
(AKA “cardiac compromise”)
any time the heart may not be getting enough oxygen
Define:
ACS
(abbreviation)
acute coronary syndrome
List:
signs/symptoms of ACS
6 points (patient complaints and body response)
- 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)
List:
patients who may have atypical presentation of ACS
3 points
- women
- diabetics
- elderly
Define:
EKG
(abbreviation)
electrocardiogram
(yeah the K is dumb)
Define:
electrocardiogram (EKG)
recording of heart’s electrical signal to check for abnormal heart conditions
Locate and define:
pulmonary valve
valve between between the heart’s right ventricle and pulmonary artery
Locate and define:
aortic valve
valve between the heart’s left ventricle and aorta
Some patients, such as [BLANK], [BLANK], and [BLANK], may experience atypical symptoms of ACS.
such as women, diabetics, and elderly
Define:
STEMI
(abbreviation)
ST segment elevation myocardial infarction
worst kind of heart attack
Define:
STEMI
(what it is)
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)
List:
treatments for ACS
5 points
- position of comfort
- supplemental oxygen
- aspirin
- nitroglycerin
- rapid transport (to cardiac center)
Define:
coronary artery disease
conditions that narrow/block arteries of heart and deprive heart muscles (myocardium) of oxygen
Fill in the blank:
Coronary artery disease is often a result of [BLANK] on the inner walls of arteries.
(pathophysiology)
Coronary artery disease is often a result of fatty deposit build-up on the inner walls of arteries.
Define:
thrombus
blood clot on the inner surface of artery
Define:
embolus
flowing piece of blood clot that breaks loose and flows to smaller artery
Define:
occlusion
blockage of blood vessel
(causes emergency in majority of cardiac-related medical emergencies)
Define:
aneurysm
weakened section of blood vessels which begin to dilate (baloon)
(rupture can cause rapid, life-threatening internal bleeding)
List:
mechanical malfunctions of the heart
3 points
- angina pectoris
- acute myocadial infarction (AMI)
- congestive heart failure (CHF)
Define:
angina pectoris
temporary chest pain caused by insufficient blood flow to the myocardium
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
Define:
AMI
(abbreviation)
acute myocardial infarction
Define:
myocardial infarction (MI)
death of a portion of myocardium due to lack of oxygen
(coronary artery is completely blocked)
Fill in the blank:
The underlying cause of AMI is typically [BLANK].
The underlying cause of AMI is typically coronary artery disease.
(AMI is acute myocardial infarction)
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
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 congestive heart failure)
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
Fill in the blank:
CHF is often a complication of [BLANK].
CHF is often a complication of AMI.
CHF is congestive heart failure
AMI is acute myocardial infarction
Fill in the blank:
[BLANK] is often a complication of AMI.
CHF is often a complication of AMI.
CHF is congestive heart failure
AMI is acute myocardial infarction
List:
stages in progression of CHF
4 points
- patient sustains AMI
- myocardium of left ventricle dies
- blood backs up into pulmonary circulation and lungs
- (if untreated) left heart failure commonly causes right heart failure
True or false:
Angina pectoris is generally relieved by over-the-counter medications.
false
True or false:
Angina pectoris can be brought on by exertion or stress.
true
True or false:
Angina pectoris generally lasts 30 to 60 minutes.
false
usually 5 minutes or less
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
Choose:
What is not a result of a mechanical malfunction of the heart?
A: Dysrhythmia
B: Cardiac arrest
C: Pulmonary edema
D: Cardiogenic shock
A
Choose:
A weakened area of an artery that balloons out and may rupture, causing catastrophic bleeding, is called:
A: an aneurysm
B: angioplasty
C: angina
D: asystole
A
Choose:
Which of the following best describes a fluttering sensation in the chest?
A: palpitations
B: pulseless electrical activity of the heart
C: dysrhythmia
D: tachycardia
A
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
Choose:
Blunt and penetrating injuries can damage chambers of the heart or cause conditions like:
A: ventricular tachycardia
B: pericardial tamponade
C: asphyxial cardiac arrest
D: ventricular fibrillation
B
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.
Choose:
In which of the following ways does cardiac arrest in children differ from cardiac arrest in adults?
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
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
Define:
pedal edema
accumulation of fluid in the feet or ankles
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C
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B
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D
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D
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C
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C
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)
List:
4 valves of the heart
(Toilet Paper My Ass)
- tricuspid valve
- pulmonary valve
- mitral valve
- aortic valve
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)
List:
risk factors for CAD
3 points
- obesity
- cigarette smoking
- possible genetic causes
(CAD is coronary artery disease)
Fill in the blank:
Angina pectoris is [PERMANENT/TEMPORARY].
Angina pectoris is temporary.
Answer:
What is the most important treatment you can provide for an AMI?
aspirin
(AMI is acute myocardial infarction)
Fill in the blank:
Unstable angina is [PERMANENT/TEMPORARY].
Unstable angina is permanent.
doesn’t go away with rest like angina should
True or false:
Aspirin should not be used in children.
true
(only for pain management maybe)
Define:
Levine’s sign
a clenched fist held over the chest to describe ischemic chest pain
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.
Define:
MI
(abbreviation)
myocardial infarction
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?
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
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.
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?
A. Aspirin 324 mg PR
B. Morphine 4 mg IV
C. Aspirin 324 mg PO
D. Nitroglycerin 0.3mg SL
C
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.
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?
A. Coronary Artery Disease (CAD)
B. Myocardial Infarction (MI)
C. Pulmonary embolism (PE)
D. Peripheral Vascular Disease (PVD)
B
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.
