Cardiac Emergencies

A hypertensive emergency usually occurs only with a systolic pressure greater than ________.

160 mm Hg

About _____ minutes after blood flow is cut off, some heart muscle cells begin to die

30

A late finding if cardiogenic shock would be a systolic blood pressure of less than __________.

90 mm Hg

Calcium and cholestrol buildup inside blood vessels

Atherosclerosis

Electrical impulses slow here to allow blood to move from the atria to the ventricles

Atrioventricular node

_ allows a cardiac muscle cell to contract spontaneously without stimulus from nerve source.

Automaticity

The only vein(s) in the body that carry oxygenated blood is/are the: A. external jugular veins B. pulmonary veins C. subclavian veins D.inferior vena cava

B. pulmonary veins

When the myocardium requires more oxygen: A. the Av node conducts fewer impulses B. the arteries supplying the heart dilate C. the heart contracts with less force D. the heart rate decreases significantly

B. the arteries supplying the heart dilate

The underlying cause of a dissecting aortic aneurysm is: A. controlled hypertension B. uncontrolled hypertension C. malignant hypertension D. benign hypertension

B. uncontrolled hypertension

Bradycardia

Unusually slow heart beat (rate), less than 60 beats/min

Ischemic heart disease is defined as: - absent myocardial blood flow due to a blocked coronary artery - death of a portion of the heart muscle due to decrease in oxygen - decreased blood flow to one or more portions of the myocardium - decreased blood flow to the heart muscle due to coronary dilation

decreased blood flow to one or more portions of the myocardium

Common side effects of nitroglycerin include all the following, except: - hypotension -severe headache - hypertension - bradycardia

hypertension

severe headache, bounding pulses, ringing in ears

hypertension emergency

After the AED has delivered a shock, the EMT should: A. assess for a carotid pulse. B. immediately resume CPR. C. reanalyze the cardiac rhythm. D. transport the patient at once.

immediately resume CPR.

tissue death

infarction

Damage to the __________ area of the heart often presents with bradycardia.

inferior

lack of oxygen

ischemia

The ___________ side of the heart is more muscular because it must pump blood into the aorta and all the other arteries of the body.

left

heart muscle

myocardium

Common signs and symptoms of AMI include all of the following, except: - shortness of breath or dyspnea - pain exacerbated by breathing - irregular heartbeat - sudden unexplained sweating

pain exacerbated by breathing

electrical impulses begin here

sinus node

Rapid heart rhythm, greater than 100 beats/min

tachycardia

Defibrillation works best if it takes place within _________ minutes of the onset of cardiac arrest. A. 2 B. 4 C. 6 D. 10

A. 2

Which of the following is NOT a cause of congestive heart failure? A. Chronic hypotension B. Heart valve damage C. A myocardial infarction D. Longstanding high blood pressure

A. Chronic hypotension

_________ carry oxygen to the body's tissues and then remove carbon dioxide. A. Red blood cells B. White blood cells C. Platelets D. Veins

A. Red blood cells

Which of the following statements regarding CHF is FALSE? A. Stridor is a common lung sound heard on exam B. it can be caused by diseased heart valves C. it can be treated with nitroglycerin D. ankle edema is a common finding

A. Stridor is a common lung sound heard on exam

Normal electrical impulses originate in the sinus node, just about the: A. atria B. ventricles C. AV junctions D. bundle of His

A. atria

When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: A. blood can pass from the artria to the ventricles B. the SA node can reset and generate another impulse C. the impulse can spread through the Purkinje fibers D. blood returning from the body can fill the atria

A. blood can pass from the artria to the ventricles

In addition to angina and mycardial infarction, nitroglycerin can be used to treat: A. congestive heart failure B. cardiogenic shock C. aortic aneurysm D. hypertensive emergency

A. congestive heart failure

Angina pain may be felt in the: A. epigastrium B. legs C. lower back D. lower abdomen

A. epigastrium

Atherosclerosis can lead to a complete ________ of a cornary artery. A. occlusion B. distintegration C. dilation D. contraction

A. occlusion

Deoxygenated blood from the body returns to the: A. right atrium B. left atrium C. right ventricle D. left ventricle

A. right atrium

The electrical impulse generated by the heart originates in the: A. sinoatrial (SA) node B. bundle of his C. coronary sinus D. atrioventricular (AV) node

A. sinoatrial (SA) node

When the battery wears out in a pacemaker, the patient may experience: A. syncope B. chest pain C. nausea D. tachycardia

A. syncope

Blood enters the right atrium from the body through the: A. vena ceva B. aorta C. pulmonary artery D. pulmonary vein

A. vena ceva

Tissues downstream from a blood clot will suffer from lack of oxygen. If blood is resumed in a short time, the ___________ tissues will recover. A. dead B. ischemic C. necrosed D. dry

B. ischemic

Which of the following changes in heart functions occur in patients with CHF? A. A decrease heart rate B. Enlargement of the left ventricle C. Enlargement of the right ventricle D. A decrease in blood pressure

B. Enlargement of the left ventricle

o assess chest pain, use the mnemonic: A. AVPU B. OPQRST C. SAMPLE D. CHART

B. OPQRST

__________ are inserted when the electrical-conrol system of the heart is so damaged that it cannot function properly. A. Stents B. Pacemakers C. Baloon angioplasties D. Defibrillations

B. Pacemakers

____________ usually refers to a state of cardiac arrest despite an organized electrical complex. A. Asystole B. Pulseless electrical activity C. Ventricular Fibrillation D. Ventricular tachycardia

B. Pulseless electrical activity

Cardiogenic shock can occur within 24 hours of a(n): A. hypertensive emergency B. acute myocardial infarction C. aortic aneurysm D. unstable angina attack

B. acute myocardial infarction

When, for a brief period of time, heart tissues fo not get enough oxygen, the pain is called: A. AMI B. angina C. ischemia D. CAD

B. angina

The lumen of an artery may be partially or completely blocked by the blood-clotting system due to a _________ that exposes the inside of the atherosclerotic wall. A. tear B. crack C. clot D. rupture

B. crack

When administering nitroglycerin to a patient, you should make sure the patient has not taken any medications for _____________ in the last 24 hours. A. angina B. erectile dysfunction C. migraine headaches D. gallbladder dysfunction

B. erectile dysfunction

Dilation of the coronary arteries ___________ blood flow: A. shuts off B. increases C. decreases D. regulates

B. increases

thromboembolism

Blood clot floating through blood vessels until it reaches a narrow area and blocks blood flow

About ___________ minutes after blood flow is cut off, come heart muscle cells begin to die. A. 10 B. 20 C. 30 D. 40

C. 30

_________ allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source. A. repitition B. reactivity C. Automaticity D. Autonomy

C. Automaticity

__________ is the maximum pressure exerted by the left ventricle as it contracts A. Cardiac output B. Diastolic blood pressure C. Systolic blood pressure D. Stroke volume

C. Systolic blood pressure

Narrowing of the coronary arteries due to a buildup of fatty deposits is called: A. angina pectoris B. arteriosclerosis C. atherosclerosis D. acute ischemia

C. atherosclerosis

An acute myocardial infarction is more likely to occur in the larger, thick-walled left ventricle, which needs more ____________ that the right ventricle. A. oxygen and glucose B. force to pump C. blood and oxygen D. electrical supply

C. blood and oxygen

The ___________ are tiny blood vessels that are approximately one cell thick. A. arterioles B. venules C. capillaries D. ventricles

C. capillaries

Which of the following is NOT a function of the sympathetic nervous system? A. dilation of blood vessels in the muscles B. constriction of blood vessels in the digestive system C. constriction of blood vessels in the muscles D. increases in the heart and respiratory

C. constriction of blood vessels in the muscles

The links in the chain of survival include all of the following EXCEPT: A. early access and CPR B. early ACLS C. early administration of nitroglycerin D. early defibrillation

C. early administration of nitroglycerin

Because the oxygen supply to the ehart is diminished with angina, the __________ can become compromised, putting the person at rick for signicant cardiac rhythm problems. A. circulation B. cardiac output C. electrical system D. vasculature

C. electrical system

Physical findings of AMI include skin that is ___________ because of poor cardiac output and the loss of perfusion. A. pink B. white C. gray D. red

C. gray

All patient assessments begin by determining whether the patient: A. is breathing B. can talk C. is responsive D. has a pulse

C. is responsive

When using the mnemonic OPQRST, the "P" stands for: A. parasthesia B. pain C. provocation D. presdisposing factors

C. provocation

The AED should be applied only to unresponsive patients with no: A. significant medical problems B. cardiac history C. pulse D. brain activity

C. pulse

Cardiac output may decrease if the heart beats too rapidly because: A. a rapid heart beat causes a decrease in the strength of cardiac contractions B. as the ehart rate increases, more blood is pumped from the ventricles that the atria C. there is not enough time in between contractions for the heart to refill completely D. the volume of blood that returns to the heart is not sufficient with fast heart rates

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

In general, a maximum of _________ dose(s) of nitroglycerin is/are given for any one episode of chest pain. A. one B. two C. three D. four

C. three

The computer inside the AED is specifically programmed to recognize rhythms that require defibrillation to correct, most commonly: A. asystole B. ventricular tachycardia C. ventricular fibrillation D. supraventricular tachycardia

C. ventricular fibrillation

Swollen ankles, rales

CHF

____________ is the most effective way to assist a person with CHF to breathe effectively and to prevent an invasive airway management technique

CPAP

Sudden death is usually the result of ___________, in which the heart fails to generate an effective blood flow. A. AMI B. athrosclerosis C. PVCs D. cardiac arrest

D. cardiac arrest

Signs and symptoms of shock include all of the following EXCEPT: A. elevated heart rate B. pale, clammy skin C. air hunger D. elevated blood pressure

D. elevated blood pressure

Risk factors for myocardial infraction include all of the following EXCEPT: A. male gender B. high blood pressure C. stress D. increased activity level

D. increased activity level

The aorta recieves its blood supply from the: A. right atrium B. left atrium C. right ventricle D. left ventricle

D. left ventricle

Which of the following blood vessels transports oxygenated blood? A. superior vena ceva B. pulmonary arteries C. inferior vena ceva D. pulmonary veins

D. pulmonary veins

The left ventricle has the thickest walls because it: A. pumps blood to the lungs to be reoxygenated B. uses less oxygen than other chambers of the heart C. receives blood directly from the systemic circulation D. pumps blood into the aorta and systemic circulation

D. pumps blood into the aorta and systemic circulation

In contrast to the sympathetic nervous system, the parasympathetic nervous system: A. prepares the body to handle stress B. dilates the blood vessels in the muscles C. causes an increase in the heart rate D. slows the heart and respiratory rates

D. slows the heart and respiratory rates

Disorganized, ineffective quivering of the ventricles is known as: A. ventricular fibrillation B. asystole C.ventricular stand still D. ventricular tachycardia

D. ventricular tachycardia

_____________ blood pressure reflects the pressure on the wealls of the arteries when the ventricle is at rest.

Diastolic

Blood clot float through blood vessels until it reasches a narrow area and block blood flow

Thromboembolism

Ischemia

Lack of oxygen

__________ __________ cells remove carbon dioxide from the body's tissues.

Red blood

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? - A rapid heart rate - generalized weakness - syncope or dizziness - heart rate less than 60 beats/min

a rapid heart rate

Cardiogenic Shock can occur within 24 hrs of an: -aortic aneurysm - unstable angina attack - acute myocardial infarction - hypertensive emergency

acute myocardial infarction

complete blockage of coronary artery

acute myocardial infarction

A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced? - thoracic aortic aneurysm - acute myocardial infarction. - uncontrolled hypertension - obstructive lung disease

acute myocardial infarction.

A 66 yr old female with history of hypertension and diabetes presents with substernal chest pressure of 2 hr duration. Her BP is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient doesn't have prescribed nitro, but her husband does. You should: - administer oxygen, give her 324 mg of aspirin, and assess further - give her one nitro, reassess her systolic blood pressure - obtain a SAMPLE history and contact medical control for advice - give her high-flow oxygen, attach the AED and transport at once.

administer oxygen, give her 324 mg of aspirin, and assess further

When, for a brief period of time, heart tissues do not get enough oxygen, the pain is called: - ischemia - coronary artery disease - angina - acute myocardial infarction

angina

exertional chest pain, relieved by nitroglycerin

angina pectoris

The _____________ is the body's main artery.

aorta

abnormal heart rhythm

arrhythmia

A 49 yr old male presents with an acute onset of crushing chest pain and diaphoresis. You should: - assess the adequacy of his respirations - administer up to three doses of nitroglycerin - administer up to 324 mg of baby aspirin - obtain vital signs and a sample history

assess the adequacy of his respirations

absence of heart electrical activity

asystole

Upper chambers of the heart

atria

Electrical impulses spread from the ____________ node to the ventricles.

atrioventricular

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: - right ventricular failure - significant hypotension - congestive heart failure - a cardiac arrhythmia

congestive heart failure

Blood vessels that supply blood to the myocardium

coronary arteries

You and your EMT partner arrive at the scene of an unresponsive 60 yo male. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approx. 5 mins. You should" - apply AED while your partner provides rescue breathing - begin CPR, apply AED, and deliver a shock if it is indicated - begin CPR and have your partner update responding medic - perform CPR only and wait for the manual defibrillator to arrive

begin CPR, apply AED, and deliver a shock if it is indicated

You and your partner arrive at the scene of a middle-aged man who collapsed about 5 mins ago. He is unresponsive, apneic, and pulseless. Bystanders are preset, haven't provided any care. You should: - perform two-rescuer CPR for 5 mins and request ALS backup. - have your partner perform CPR while you question the bystanders. - immediately apply the AED pads and analyze his cardiac rhythm. - begin high quality CPR and apply the AED ASAP.

begin high quality CPR and apply the AED ASAP.

You are dispatched to the residence for a 56 yr old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and a thready pulse. You should: - attach the AED immediately - apply a NRB mask - begin ventilatory assistance - obtain baseline vital signs

begin ventilatory assistance

Unusually slow heart rhythm, less than 60 beats/min

bradycardia

Atherosclerosis

calcium and cholesterol buildup inside blood vessels.

Which of the following statements regarding the pain associated with AMI is correct? - it often fluctuates in intensity when patient breathes - can occur during exertion or when patient at rest - often described by patient as sharp feeling - nitroglycerin usually resolves pain within 30 mins

can occur during exertion or when patient at rest

Heart lacks pumping power, low blood pressure

cardiogenic shock

Cardiogenic shock following AMI is caused by; - decreased pumping force of the heart muscle - hypovolemia secondary to severe vomiting - a profound increase in the patient's heart rate - widespread dilation of the systemic vasculature

decreased pumping force of the heart muscle

A 40 yr 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 implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? - avoid defibrillate as this will damage the patient's AICD - contact medical control and request permission to defibrillate. - deliver the shock followed by immediate resumption of CPR - continue CPR and transport the patient to the closest appropriate hospital

deliver the shock followed by immediate resumption of CPR

The collection of fluid in the part of the body that is closest to the ground is called ______ _______.

dependent edema

Blood supply to the heart is increased by _________ of the coronary arteries.

dilation

sudden tearing, seperation of lining, potential for great blood loss

dissecting aneurysm

Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort? - history of previous heart attack - presence of personal risk factors - family history of hypertension -history of cigarette smoking

family history of hypertension

The heart has _______ chambers.

four

At 0500 hours, you respond to the home of a 76 yr old man complaining of chest pain. Upon arrival, the patient states that he had been sleeping in the recliner all night due to indigestion, when the pain woke him up. He also tells you he has taken two nitroglycerin tablets. His vital signs are as follows: respirations, 16 beats/min; pulse, 98 beats/min; blood pressure, 92/76 mm Hg. He is still complaining of chest pain. What actions should you take to intervene? - provide high-flow oxygen - apply an AED - administer a third nitro tablet. - Begin chest compressions

provide high- flow oxygen

In CHF, blood tends to back up in the _______ ________, increasing the pressure in the capillaries of the lungs.

pulmonary veins

The only veins in the body that carry oxygenated blood are the: - external jugular veins - pulmonary veins - subclavian veins - inferior vena cava

pulmonary veins

tachycardia

rapid heart rate over 100 beats per minute

You are assessing a 49 yr old man who complains of chest pressure that began the night before. He's conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and bite that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his BP is 78/58 mm Hg, and his pulse is 110 beats/min and irregular. You should: - remove the nitro patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport. - ask him if the nitro patch he is wearing has improved his chest pressure, complete secondary assessment, and transport promptly. - immediately remove nitro patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital. - move the nitro patch to the other side of his chest in case you need to apply the AED, keep him warm, and transport without delay.

remove the nitro patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.

Most AEDs are set up to adjust the voltage based on the impedance, which is the: - resistance of the body to the flow of electricity - actual amount of energy that the AED will deliver - direction the electrical flow takes in body - distance between two AED pads on chest.

resistance of the body to the flow of electricity

The ____________ ventricle pumps blood in through the pulmonary circulation.

right

Deoxygenated blood from the body returns to the: - left ventricle - right ventricle - right atrium - left atrium

right atrium

The heart is divided down the middle by a wall called the ______________.

septum

A dissecting aortic aneurysm occurs when: - the inner layers of the aorta become separated - all layers of the aorta suddenly contract - a weakened area develops in the aortic wall. - the aorta ruptures, resulting in profound bleeding.

the inner layers of the aorta become separated

In general, a maximum of _ doses of nitroglycerin are give for any one episode of chest pain

three

infarction

tissue death

carry oxygen poor blood back to the heart

venae cavae

Lower chambers of the heart

ventricles

Nitro is contraindicated in patients: - who have taken up to two doses - with a systolic BP less than 120 mm Hg - who have experienced a head injury - with a history of an ischemic stroke

who have experienced a head injury