Chapter 32: Multiple Choice

The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?

Serum biochemical markers

The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?

Kussmaul sign

dilated cardiomyopathy

Mixed

Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever and rheumatic heart disease. This occurs through what phenomenon?

Molecular mimicry

During an acute myocardial infarction, there is an ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "widow of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

20-40 mins

It is known that more than 100 distinct myocardial diseases (DCM) can demonstrate clinical features associated with dilated cardiomyopathy. What is the most common identifiable cause of DCM in the US?

Alcoholic cardiomyopathy

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect due to the right to left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hyper-cyanotic attack brought on by period of stress

Myocarditis

Acquired

Peripartum cardiomyopathy

Acquired

ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving symptoms and preventing complications of this disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

B-adrenergic blocking drugs

When acute myocardial infarction occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

Conversion from aerobic to anaerobic metabolism

Angina pectoris is a chronic ischemic coronary artery disease that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?

Emotional stress

Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?

During feeding

Left Ventricular noncompaction

Genetic

hypertrophic cardiomyopathy

Genetic

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset and sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?

Have the patient sit up and lean forward

Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?

Pulsus paradoxus

Unstable angina/non ST-segment elevation myocardial infarction is a clinical syndrome that ranges in severity between stable angina to myocardial infarction. It is classified according to its risk of causing an acute MI and is diagnosed based on what?

Serum biomarkers ECG pattern

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture. Make all that apply.

Size of lipid-rich core Presence of inflammation Thickness of fibrous cap

In effective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin stands of clotted blood. What are the possible systemic effects of these vegetative lesions?

They can fragment and cause cerebral emboli

A patient with a suspected myocardial infarction is brought to the emergency department by ambulance. As the nurse caring for this patient, what lab work would you expect to receive an order for to confirm a diagnosis of MI?

Troponin level