Chapter 15- Cardiovascular Emergencies
What three major arteries arise from the aortic arch?
Brachiocephalic, left common carotid, and left subclavian
A 62-year-old female with a history of hypertension and diabetes presents with a sudden tearing sensation in her abdomen. She tells you that the pain has been of maximum intensity since its onset. Based on her chief complaint, what additional assessment findings would you expect to encounter?
Diminished pulses in her lower extremities
During your primary assessment of an unresponsive 47-year-old male, you find that he has occasional gasping breaths. You should:
During your primary assessment of an unresponsive 47-year-old male, you find that he has occasional gasping breaths. You should:
Which of the following questions would be of LEAST pertinence when obtaining a focused history of a patient with an acute onset of chest discomfort?
Have you ever been told you have low blood pressure?
Which of the following would likely exacerbate pulmonary edema?
Increased cardiac preload
Which of the following is NOT a component of the cardiac electrical conduction system?
Interatrial septum
Which of the following cardiac dysrhythmias requires immediate defibrillation?
Nonperfusing ventricular fibrillation
Which of the following MOST accurately describes the pathophysiology of angina pectoris?
Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen
Which of the following represents the correct sequence of electrical conduction through the myocardium?
SA node, AV node, Bundle of His, bundle branches, Purkinje fibers
Which of the following clinical presentations is consistent with a malfunctioning implanted pacemaker?
Syncope and bradycardia
Which layer of the blood vessel is composed of elastic tissue and smooth muscle cells, which allow the vessel to expand or contract in response to the body's demands?
Tunica media.
What are the physiologic effects of nitroglycerin when given to a patient with suspected cardiac-related chest pain?
Vascular smooth muscle relaxation and coronary artery dilation
Which of the following cardiac rhythms or conditions requires defibrillation?
Ventricular tachycardia without a pulse
When assessing a middle-aged male patient with chest pain, you note a large vertical scar in the center of his chest. This indicates that he has MOST likely had:
a coronary artery bypass graft.
When defibrillating a 6-month-old infant, you should recall that:
a manual defibrillator is preferred.
Pulseless electrical activity (PEA) exists when:
a patient is in cardiac arrest despite an organized cardiac rhythm.
One of the MOST common signs of an acute hypertensive emergency is:
a sudden, severe headache.
When treating a 56-year-old female with chest pain, you have placed on her oxygen, established IV access, and administered two doses of sublingual nitroglycerin. However, the patient's pain has not improved. You reassess her blood pressure and note that it is 106/66 mm Hg. You should:
administer one more dose of nitroglycerin.
While treating a patient who is in cardiogenic shock, your paramedic partner makes the comment that the patient needs an inotropic medication. You should recall that this type of medication is intended to:
affect the strength of cardiac contraction
When peripheral vascular resistance is increased:
afterload increases and stroke volume decreases.
You should be MOST suspicious that a patient is experiencing an acute myocardial infarction if he or she presents with:
an acute onset of weakness, nausea, and sweating without an obvious cause.
The term acute coronary syndrome (ACS) is used to describe:
any group of symptoms consistent with acute myocardial ischemia.
A 55-year-old male with poorly controlled hypertension presents with respiratory distress and difficulty speaking in complete sentences. He is conscious and alert with a blood pressure of 150/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 28 breaths/min and labored. Auscultation of his lungs reveals diffuse coarse crackles. After placing the position in a comfortable position, you should:
apply the CPAP device.
When applying the AED pads to a patient with a surgically-implanted pacemaker, you should:
apply the pads at least 1" away from the pacemaker
The coronary arteries of a person with arteriosclerotic heart disease:
are thickened and hardened and lose their elasticity.
During your primary assessment of an unresponsive 47-year-old male, you find that he has occasional gasping breaths. You should:
assess for a carotid pulse and begin chest compressions if needed.
You are transporting a 55-year-old female with chest pain, who has not responded to 3 doses of nitroglycerin. As you are talking to her, she becomes unresponsive and apneic. You should:
assess her pulse, tell your partner to stop the vehicle, begin CPR, and analyze her cardiac rhythm with an AED.
A 49-year-old male complains of acute chest discomfort. He is conscious but restless, and he is noticeably diaphoretic. As your partner is applying 100% oxygen, the patient hands you a bottle of nitroglycerin that was prescribed to him by his family physician. Prior to assisting the patient with his medication, you should:
assess his systolic BP to ensure that it is at least 100 mm Hg.
A 71-year-old man presents with shortness of breath, facial cyanosis, and a cough that is producing blood. His blood pressure is 144/92 mm Hg, pulse is 130 beats/min and irregular, and respirations of 28 breaths/min and labored. He is confused and is slow follow your commands. You should:
assist his ventilations with a bag-mask device, begin transport, and consider establishing IV access en route to the hospital.
A 60-year-old female is in possible cardiogenic shock. She is semiconscious with shallow respirations, an irregular pulse, and hypotension. Appropriate treatment for this patient should include:
assisted ventilation with a bag-mask device, thermal management, 20 mL/kg fluid bolus, and transport.
The tricuspid and mitral valves of the heart are referred to as:
atrioventricular valves.
The ability of a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source is called:
automaticity.
When assessing a patient for peripheral edema, you should check the sacral area if the patient is:
bedridden
You respond to call at a residence for a "man down." Your primary assessment reveals that the patient, a 66-year-old male, is unresponsive, pulseless, and apneic. His wife tells you that he has recently had the flu, and that he collapsed about 10 minutes ago. You should:
begin CPR and apply the AED as soon as it is available.
You are assessing a 62-year-old female who has an automatic implantable cardiac defibrillator (AICD). As you are applying oxygen to her, she becomes unconscious, pulseless, and apneic. You should:
begin CPR and apply the AED as soon as possible.
You are dispatched to a residence for a 4-year-old male who is not breathing. When you and your partner arrive at the scene, you find the child's father is performing mouth-to-mouth rescue breathing on him. The father tells you that his son stuck a pin in an electrical socket. After assessing the child and determining that he is pulseless and apneic, you should:
begin CPR and apply the AED as soon as possible.
Following defibrillation with the AED, you have achieved return of spontaneous circulation (ROSC) in a 42-year-old man. However, he remains unresponsive and apneic. You insert a multilumen airway device, continue ventilations, and begin immediate transport to the hospital. En route, you reassess the patient and determine that he is in cardiac arrest. You should:
begin CPR, tell your partner to stop the ambulance, and analyze the patient's cardiac rhythm with the AED.
After defibrillating an adult patient in cardiac arrest with the AED, you should:
begin or resume CPR starting with chest compressions.
Unstable angina pectoris is characterized by:
chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency.
When the papillary muscles contract, the ______________ tighten, preventing blood from regurgitating from the ventricles to the atria.
chordae tendineae
Common signs of left-sided congestive heart failure include all of the following, EXCEPT:
chronic pedal edema.
Which of the following MOST accurately describes the correct sequence of events after attaching an AED to a patient in cardiac arrest and pushing the analyze button?
"Shock advised" message, stand clear, defibrillate, immediately resume CPR, reanalyze after 2 minutes
You receive a call for a 40-year-old female with nausea, dizziness, and a headache. During your assessment, you note that her blood pressure is 190/104 mm Hg. The patient, who is conscious and alert, states that she has a history of hypertension, but admits to being noncompliant with her medications. In addition to IV therapy, appropriate treatment for this patient includes:
100% oxygen and transporting to the closest appropriate facility.
Damage to the myocardium following infarction can be minimized if fibrinolytic therapy is administered no later than _____ hours following the onset of symptoms.
12
You receive a call to a local grocery store for a possible heart attack. Upon arrival at the scene, you find two bystanders performing CPR on the patient, a 49-year-old male. You should:
confirm that the patient is in cardiac arrest.
The presence of distended jugular veins that do not collapse, even when the patient is sitting, is consistent with:
congestive heart failure.
According to Starling's Law of the Heart:
contractility increases as the myocardial walls are stretched.
The _____________ arteries arise from the aorta shortly after they leave the left ventricle.
coronary
The _____________ is the end of the great cardiac vein and collects blood returning from the walls of the heart.
coronary sinus
Prinzmetal's angina is caused by:
coronary vasospasm.
A 67-year-old male presents with an altered mental status following two days of severe chest pain. His wife tells you that he would not allow her to call EMS. Your assessment reveals a tachycardic, irregular pulse, diaphoresis, and a blood pressure of 80/50 mm Hg. You should suspect:
decompensated cardiogenic shock.
Approximately 60% to 70% of deaths due to acute myocardial infarction occur:
during the first 2 to 3 hours after symptom onset.
The percentage of blood pumped from the heart is called:
ejection fraction.
After applying the AED to your cardiac-arrest patient, you receive a "shock advised" message. You should:
ensure that all contact with the patient has ceased.
Treatment for a patient experiencing a cardiovascular emergency begins by:
ensuring airway patency and adequate breathing.
The visceral pericardium, which lies closely against the heart, is also called the:
epicardium
The visceral pericardium, which lies closely against the heart, is also called the:
epicardium.
The ability of cells to respond to electrical impulses is referred to as the property of:
excitability.
When errors associated with the AED occur, it is usually the result of:
failure to ensure the batteries are charged.
When treating a patient with a blood pressure of 80/40 mm Hg due to "pump failure," you should:
give a 20 mL/kg crystalloid fluid bolus to improve perfusion.
Nitroglycerin is contraindicated for patients who:
have experienced a head injury.
A patient with acute chest discomfort took two of his prescribed nitroglycerin tablets and is now experiencing a pounding headache. However, he tells you that he is still experiencing chest discomfort. You should suspect that:
he is experiencing ongoing myocardial ischemia.
Stimulation of the sympathetic nervous system results in:
increased blood pressure and heart rate.
An acute myocardial infarction is more apt to occur in the left ventricle because:
it is large and thick and demands more oxygen than the right ventricle.
The left main coronary artery rapidly divides into the:
left anterior descending and circumflex arteries.
Effectively performed CPR is a crucial treatment for a patient in cardiac arrest because it:
maintains myocardial and cerebral perfusion.
Percutaneous coronary intervention (PCI) involves:
mechanically clearing a coronary artery.
Approximately two-thirds of the myocardium lies within the:
mediastinum.
Damage to the ___________ valve may cause blood to regurgitate into the lungs.
mitral
The middle, muscular layer of the heart is called the:
myocardium.
A 33-year-old male complains of generalized weakness and chest discomfort that began following his morning workout at the gym. He is conscious and alert, but restless. Your assessment reveals a BP of 130/64 mm Hg, pulse of 78 beats/min and occasionally irregular, respirations of 16 breaths/min and unlabored, and an SpO2 of 98% on room air. He has prescribed nitroglycerin tablets and states that he took one without relief. Appropriate treatment for this patient includes:
oxygen via nasal cannula, up to 324 mg aspirin, saline lock, additional nitroglycerin per medical control, and transport.
The _____________ anchors the heart within the thoracic cavity and prevents cardiac overdistention.
pericardium
Shortly after administering a second nitroglycerin dose to a 44-year-old male with chest pain, he becomes lightheaded. You take his blood pressure and is reads 80/50 mm Hg. You have already established IV access and are administering oxygen. You should:
place him supine and elevate his legs.
As with angina, the pain associated with acute myocardial infarction is often described as:
pressure
Afterload is defined as the:
pressure against which the left ventricle must pump.
As with angina, the pain associated with acute myocardial infarction is often described as:
pressure.
When given to a patient who is experiencing an acute coronary syndrome, aspirin works by:
preventing an existing clot from getting larger.
A middle-aged male presents with classic signs and symptoms of a dissecting aortic aneurysm. The MOST important intervention that you can perform for this patient is:
prompt transport.
Erythropoiesis is the ongoing process by which:
red blood cells are made.
Asystole has an exceedingly high mortality rate because it:
reflects a prolonged period of myocardial ischemia.
The aortic valve:
regulates the flow of blood from the left ventricle to the systemic circulation.
A 50-year-old female is in cardiac arrest. You attach the AED and receive a "no shock advised" message. You should:
resume CPR and reanalyze her cardiac rhythm after 2 minutes.
After defibrillating a patient in cardiac arrest with the AED, you should:
resume chest compressions.
resume chest compressions.
resume chest compressions.
During your assessment of a woman with chronic shortness of breath and fatigue, you ask her how many pillows she sleeps with at night. You are asking her this question to determine if:
she has left-sided heart failure and how severe it may be.
A hypertensive crisis is considered to be a true emergency when:
signs of central nervous system dysfunction are present.
The normal site of origin of electrical impulses in the heart is the ____________, which generates ___________ impulses per minute.
sinoatrial node, 60 to 100
The primary function of the atrioventricular (AV) node is to:
slow conduction from the atria to the ventricles to allow for ventricular filling.
When the parasympathetic nervous system is stimulated, it:
slows the heart rate by decreasing SA node discharge.
A 56-year-old male with a history of coronary artery disease complains of an acute onset of substernal chest discomfort and diaphoresis while moving a heavy box. After sitting down and taking one nitroglycerin tablet, the discomfort promptly subsides. This episode is MOST consistent with:
stable angina pectoris.
The term that refers to the contraction of the ventricular mass and the pumping of blood into the systemic circulation is called:
systole.
The fifth link in the cardiac chain of survival includes:
temperature regulation and maintenance of glucose levels.
If the heart's natural pacemaker is not functioning properly:
the AV node may take over and pace the heart at 40 to 60 beats/min.
A patient with acute chest discomfort took two of his prescribed nitroglycerin tablets and is now experiencing a pounding headache. However, he tells you that he is still experiencing chest discomfort. You should suspect that:
the patient is experiencing ongoing myocardial ischemia.
Ventricular tachycardia often causes hypotension because:
there is not enough time between beats for the left ventricle to fill with blood.
Compared to monophasic defibrillation, biphasic defibrillation is advantageous because it:
utilizes less energy to achieve effective defibrillation.
Blood enters the right atrium through the:
vena cavae and coronary sinus.
The MOST common cardiac dysrhythmia associated with sudden cardiac death following an acute myocardial infarction is:
ventricular fibrillation.
Which of the following patients would be LEAST likely to experience the classic signs and symptoms of an acute myocardial infarction (AMI)?
A 67-year-old female with diabetes mellitus
Which of the following statements regarding the automated external defibrillator (AED) is NOT correct?
A pulse should be checked immediately after the AED shocks.
Which of the following valves of the heart are semilunar valves?
Aortic and pulmonic
What part of the cardiac electrical conduction system initiates electrical impulses at the slowest rate?
Areas below the AV node
You are dispatched to a residence for a 59-year-old male with an unknown emergency. When you arrive, you find the patient sitting on the couch. He is conscious, is noticeably diaphoretic, and complains of dizziness and weakness. During your assessment, you note a large, well-healed vertical scar in the center of his chest and a small bulge just under the skin in the upper left part of his chest. His blood pressure is 90/50 mm Hg, pulse is 44 beats/min and weak, and respirations are 24 breaths/min and unlabored. What is the MOST likely cause of this patient's condition?
Artificial pacemaker failure
You are dispatched to a residence for a 59-year-old male with an unknown emergency. When you arrive, you find the patient sitting on the couch. He is conscious, noticeably diaphoretic, and complains of dizziness and weakness. During your assessment, you note a large, well-healed vertical scar in the center of his chest and a small bulge just under the skin in the upper left part of his chest. His blood pressure is 90/50 mm Hg, pulse is 44 beats/min and weak, and respirations are 24 breaths/min and unlabored. What is the MOST likely cause of this patient's condition?
Artificial pacemaker failure
In addition to oxygen, which of the following medications would the AEMT be the MOST likely to administer to a patient who is experiencing acute chest pain, pressure, or discomfort?
Aspirin and nitroglycerin
