Chapter 14

an emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm

hypertensive emergency

The purpose of defibrillation is to:

A. stop the chaotic, disorganized contraction of the cardiac cells.

Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?

Administer the medication sublingually and allow it to dissolve or absorb.

Which of the following is a major difference between angina pectoris and AMI?

Anginal pain typically subsides with rest.

Which of the following is the MOST reliable method of estimating a patient's cardiac output?

Assess the heart rate and strength of the pulse.

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?

Deliver the shock followed by immediate resumption of CPR.

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What are her signs and symptoms MOST indicative of?

Dissecting aortic aneurysm

Major risk factors for AMI include all of the following, EXCEPT:

Hypoglycemia.

Which of the following statements regarding nitroglycerin is correct?

Nitroglycerin usually relieves anginal chest pain within 5 minutes.

Which of the following blood vessels transports oxygenated blood?

Pulmonary veins

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:

Stop the ambulance, begin CPR, and attach the AED as soon as possible.

Ventricular tachycardia causes hypotension because:

The left ventricle does not adequately fill with blood.

When documenting a patient's description of his or her chest pain or discomfort, the EMT should:

Use the patient's own words.

a term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction

acute coronary syndrome

a heart attack; death of heart muscle following obstruction of blood flow to it

acute myocardial infarction (AMI)

transient (short lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle

angina pectoris

the front surface of the body; the side facing you in the standard anatomic position

anterior

an irregular or abnormal heart rhythm

arrhythmia

Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:

assess the scene for potential hazards.

the complete absence of any electrical cardiac activity, appearing as a straight or almost straight line on an ECG strip

asystole

a disorder in which cholesterol and calcium build up inside the walls of the blood vessels , forming plaque, which eventually leads to partial or complete blockage of blood flow

atherosclerosis

one of two (right and left) upper chambers of the heart. The right one receives blood from the vena cava and delivers it to the right ventricle. The left one receives blood from pulmonary veins and delivers it to the left ventricle

atrium

the ability of cardiac muscle cells to contract without stimulation from the nervous system

automaticity

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:

automaticity.

the part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion and sweating

autonomic nervous system

You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:

begin high-quality CPR and apply the AED without delay.

a slow heart rate, less than 60 beats/min

bradycardia

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:

brain

a state in which the heart fails to generate effective and detectable blood flow; pulses are not palpable, even if muscular and electrical activity continues in the heart.

cardiac arrest

a measure of the volume of blood circulated by the heart in 1 min, calculated by multiplying the stroke volume by the heart rate

cardiac output

a disorder in which the heart loses part of its ability to effectively pump blood usually a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs

congestive heart failure (CHF)

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspect:

congestive heart failure.

the blood vessels that carry blood and nutrients to the heart muscle

coronary arteries

The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.

coronary arteries, aorta

to shock fibrillating (chaotically beating) heart with specialized electrical current in an attempt to restore a normal, rythmic beat

defibrillate

swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure

dependent edema

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:

dilating the affected coronary artery with a small inflatable balloon.

widening of a tubular surface such as a coronary artery

dilation

a condition in which the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressures) of flow between the layers

dissecting aneurysm

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to not being compliant with her regimen of antihypertensive medications. During the primary assessment, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate?

dissecting aortic aneurysm

Risk factors for AMI that cannot be controlled include:

family history

Which of the following is LEAST important when obtaining a medical history from a patient with a chief complaint of chest discomfort?

family history of hypertension

Blood that is ejected from the right ventricle:

flows into the pulmonary arteries.

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:

have chronic hypertension.

Common side effects of nitroglycerin include all of the following, EXCEPT:

hypertension

death of a body tissue, usually caused by interruption of its blood supply

infarction

the part of the body or any body part nearer to the feet

inferior

a lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred

ischemia

the inside diameter of an artery or other hollow structure

lumen

A patient with atherosclerotic heart disease experiences chest pain during exertion because the:

lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

Angina pectoris occurs when:

myocardial oxygen demand exceeds the supply

the heart muscle

myocardium

a blockage, usually of a tubular structure such as a blood vessel

occlusion

Common signs and symptoms of AMI include all of the following, EXCEPT:

pain exacerbated by breathing.

a subdivision of the autonomic nervous system, involved in control of involuntary, vegetative functions, mediated largely by the vagus nerve through the chemical acetylcholine

parasympathetic nervous system

circulation of blood within an organ or tissue in adequate amounts to meet the current needs of the cells

perfusion

A 67-year-old woman presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:

placing her in an upright position.

in anatomy, the back surface of the body; the side away from you in the standard anatomic position

posterior

After assisting your patient with prescribed nitroglycerin, you should:

reassess the blood pressure within 5 minutes to detect hypotension.

The electrical impulse generated by the heart originates in the:

sinoatrial (SA) node.

the volume of blood ejected with each ventricular contraction

stroke volume

the part of the body or any body part nearer to the head

superior

the part of the autonomic nervous system that controls active functions such as responding to fear ( also known as the flight-or flight system)

sympathetic nervous system

a fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain

syncope

a rapid heart rate, more than 100 beats/min

tachycardia

Cardiac output may decrease if the heart beats too rapidly because:

there is not enough time in between contractions for the heart to refill completely.

a blood clot that has formed within a blood vessel and is floating within the bloodstream

thromboembolism

The descending aorta divides into the two iliac arteries at the level of the:

umbilicus.

one of two lower chambers of the heart

ventricle

Sudden death following an AMI is MOST often caused by:

ventricular fibrillation

disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest

ventricular fibrillation

a rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium) which may result in adequate blood flow and eventually deteriorate into cardiac arrest

ventricular tachycardia

Common signs and symptoms of a hypertensive emergency include:

A bounding pulse, a severe headache, and dizziness.

the main artery that receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body

aorta

a weakness in the wall of the aorta that makes it susceptible of rupture

aortic aneurysm

the one-way valve that lies between the left ventrile and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta one of the four hear valves

aortic valve

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. it can be a severe complication of a large acute ,myocardial infarction, as well as other conditions

cardiogenic shock