Ischemic Heart Disease Flashcards
Question 1 of 5
Myocardial infarction _________________________. Select all that apply.
usually resolves on its own, without any treatment.
is synonymous with myocardial ischemia.
results from increased oxygenation of heart tissue.
indicates death of heart tissue.
may produce abnormalities on an ECG.
Indicates death of heart tissue.
may produce abnormalities on an ECG.
Question 2 of 5
Which of the following statements about angina are true? Select all that apply.
Stable angina is considered a medical emergency.
Unstable angina may indicate new damage to the heart.
Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium.
Increased oxygen levels and lactic acid formation may play a role in angina.
Unstable angina is chest pain the patient is experiencing for the first time.
Unstable angina may indicate new damage to the heart.
Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium.
Unstable angina is chest pain the patient is experiencing for the first time.
Question 3 of 5
As a nurse working the emergency department, which of the following signs and symptoms are you concerned may indicate a patient is experiencing angina? Select all that apply.
Pain alleviated with nitrates Muscle weakness Pain radiating to the jaw and neck Fever Levine’s sign
Pain alleviated with nitrates
Pain radiating to the jaw and neck
Levine’s sign
Question 4 of 5
Of the following characteristics, which is associated with a STEMI?
Partial occlusion of coronary artery
Partial thickness damage of heart muscle
ST segment elevation
Relatively benign condition
ST segment elevation
Question 5 of 5
Which of the following treatments utilizes a catheter with a balloon that is inflated to restore blood flow?
STEMI
NSTEMI
PTCA
CABG
PTCA
Question 1 of 9
Helen is a 68-year-old woman who has been brought to the emergency department by her friend Karen. According to Karen, she and Helen had been working for several hours cleaning Helen’s home. As they were finishing, Helen began to complain of heaviness in her chest, shortness of breath, and dizziness. These were not alleviated by Helen taking a nitroglycerin tablet and resting so Karen thought it best to bring Helen in for evaluation.
As Helen experienced her symptoms, why may nitroglycerin tablets help?
Nitroglycerin is known to alleviate dizziness.
Nitroglycerin vasodilates arterioles helping with coronary blood flow.
Nitroglycerine tablets are antianxiety medications.
Nitroglycerin increases heart rate helping to maintain cardiac output.
Nitroglycerin vasodilates arterioles helping with coronary blood flow.
Nitroglycerin vasodilates arterioles, helping to maintain blood flow to coronary tissue and alleviating chest pain.
Question 2 of 9
Given Helen’s medical history, as well as her shortness of breath and feeling of dizziness, you believe she may be suffering from a myocardial infarction. The signs and symptoms of myocardial infarction may present differently in women. Which term applies to the signs and symptoms that may be present in a myocardial infarction that are not considered to be the typical presentation of chest pain?
Levine’s sign
Angina equivalents
Intermittent leg claudication
Cushing’s triad
Angina equivalents
Angina equivalents are signs and symptoms associated with a myocardial infarction that differ from the typical angina pectoris presentation. Levine’s sign is when a patient suffering from a myocardial infarction places his or her fist over the sternal area. Intermittent leg claudication and Cushing’s triad are not associated with myocardial infarctions.
Question 3 of 9
Because of the concern of myocardial infarction (MI), the physician orders an electrocardiogram (ECG), which reveals Helen has ST segment elevation. Which of the following statements are true? Select all that apply.
An ECG is the most definitive diagnostic test for an MI.
Helen’s results indicate the presence of STEMI.
The ST segment elevation is a positive indicator for adequate perfusion of the heart.
Helen’s ECG indicates the next appropriate step is for Helen to be sent home with instructions to rest and drink plenty of fluids.
The ECG results help explain why Helen was experiencing angina equivalents.
Helen’s results indicate the presence of STEMI.
The ECG results help explain why Helen was experiencing angina equivalents.
An ECG is not the diagnostic test for MI, although it may provide important clinical information. The ST segment elevation indicates that Helen is likely experiencing a STEMI (ST segment elevation MI), causing complete occlusion of a coronary artery. The arterial occlusion would explain why Helen was experiencing angina equivalents.
Question 4 of 9
The physician also orders a blood test for Helen. Which factor supports a diagnosis of myocardial infarction? Elevated LDL levels Elevated HDL levels Elevated Hct levels Elevated cardiac troponin I
Elevated cardiac troponin I
Cardiac troponin I is a factor released from cardiac cells undergoing necrosis. This factor elevates in the blood after myocardial infarction and is considered to be the preferred biomarker for myocardial infarction. Creatine phosphokinase myocardial band is another cardiac marker; however, the absence of this factor in the blood would indicate an MI is likely not occurring. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and hematocrit (Hct) levels are not indicative of MI.
Question 5 of 9
The physician requests that the cardiac biomarkers be tested over time. Which of the following is the expected pattern that may be present in Helen’s samples?
Both cardiac troponin I and creatine phosphokinase myocardial band peak within 30 minutes of myocardial infarction.
Cardiac troponin I and creatine phosphokinase myocardial band will present with an inverse relationship. As one factor elevates, the other factor decreases.
Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain.
Cardiac biomarkers return to baseline within hours of the onset of chest pain.
Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain.
Cardiac troponin I level rises within 4 to 8 hours of onset of chest pain. The cardiac biomarkers do not return to baseline levels for several days. The cardiac biomarkers do not have an inverse relationship; rather, with damage of myocardial cells, both cardiac biomarkers increase in the serum.
Question 6 of 9
Helen’s vital signs show a heart rate of 82 bpm, BP of 118/78 mm Hg, respiratory rate of 28 breaths per minute, and oxygen saturation of 93%. At the current time, what medication options may be selected for Helen? She continues to complain of heaviness in her chest.
Select all that apply:
Oxygen
Aspirin
IV nitrates
Morphine
Beta-adrenergic blockers
Oxygen
Aspirin
IV nitrates
Morphine
Beta-adrenergic blockers
All of the listed options can be used to manage myocardial infarctions. Oxygen is given if saturation levels are less than 95%, aspirin reduces platelet aggregation, and nitrates and morphine may be used to alleviate pain. Beta blockers reduce the workload on the heart.
Question 7 of 9
Which test is most helpful in revealing the extent of damage to Helen’s heart?
Echocardiogram
Coronary artery bypass grafting (CABG)
Venogram
Radionuclide myocardial perfusion imaging
Radionuclide myocardial perfusion imaging
Radionuclide myocardial perfusion imaging involves injecting a radionuclide dye into the bloodstream to highlight areas of the heart lacking perfusion. An echocardiogram cannot differentiate an acute MI from an old one, and a venogram examines the veins, not the coronary arteries.
Question 8 of 9
A follow-up angiography shows an occlusion in the left anterior descending artery. Percutaneous coronary intervention (PCI) was used to restore perfusion. Which of the following likely occurred for Helen during PCI?
Drug-eluting stent placement
Thallium stress test
Heart valve replacement
Aortic dissection
Drug-eluting stent placement
A drug-eluting stent may be placed in the coronary artery to restore perfusion. Heart valve replacement is not considered during an MI. Thrombolytics rather than administration of clotting factors would be a treatment for myocardial infarction.
Question 9 of 9
You are concerned that during Helen’s treatment there may be further injury to myocardial cells by normalized oxygen levels. What is the term used for this type of injury? Reentry injury Repolarization injury Angina equivalents Reperfusion injury
Reperfusion injury
Reperfusion injuries occur because damaged myocardial cells poorly tolerate normalized levels of oxygen.
Question 1 of 5
Stable angina _____________________.
is chest pain experienced for the first time.
is another name for a heart attack.
is consistent, chronic chest pain.
requires immediate surgical correction.
is consistent, chronic chest pain.
