Chapter 17

The PR interval should be no shorter than _____ seconds and no longer than ______ seconds in duration.

0.12, 0.20

When managing cardiac arrest, the appropriate dosing regimen for epinephrine is:

1 mg of a 1:10,000 solution every 3 to 5 minutes.

Cardiac symptoms of myocarditis usually appear ______ days after the onset of initial symptoms.

10 to 14

The normal P wave duration is less than _____ milliseconds and the amplitude is less than ____ millimeters tall.

110, 2.5

Your patient has a BP of 220/110. What is this patients mean arterial pressure (MAP)?

147 mm HG

A "run" of ventricle tachycardia occurs if at least ____ PVCs occur in a row.

3

In males, the QT interval is considered prolonged if it is _____ milliseconds or longer.

450

If the R-R interval spans more than ____ large boxes on the ECG graph paper, the heart rate is less than 60/min.

5

Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction?

58- year - old diabetic woman

The door-to-balloon time for a patient with an ST elevation myocardial infarction is _____ minutes or less.

90

A "runaway" pacemaker is characterized by:

A tachycardic pacemaker rhythm.

A middle age man in ventricular fibrillation has been refractory to several biphasic defibrillations, well coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next?

Administer 300 mg of amiodarone via rapid IV push.

A 56 year old man presents with an acute chest pressure, shortness of breath, and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should:

Administer supplemental oxygen

What drug is indicated for patients with refractory ventricular fibrillation?

Amiodarone

Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder?

An S3 sound during auscultation of the heart.

Which of following statements regarding asystole is correct?

Asystole is the result of prolonged myocardial hypoxia.

Which of the following would MOST likely cause bradycardia?

Beta-blocker use

Cor pulmonale is MOST often the result of:

COPD

A 55 year old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since it's onset. His medical history includes hypertension, and he admits to being non compliant with his anti hypertensive medications. Which of the following assessment findings would most likely reinforce you suspicion regarding the cause of his pain?

Differences in blood pressure between the two arms

Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take?

Digitalis and Coumadin

A right sided ECG is indicated for patients who presents with:

ECG evidence of an inferior infarction.

A 60 year old woman presents with fever, chills, and shortness of breath. She has a history of mitral valve prolapse. Assessment reveals flat, painless red lesions on the palms of her hands. What should you suspect?

Endocarditis

Which of the following mechanisms causes hypertension?

Increase afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.

The __________ represents the end of ventricular depolarization and the beginning of repolariztation,

J point

Which of the following statements is correct?

Lead III is contiguous with leads II and aVF.

A 60 year old man with crushing chest pain has 3mm of ST elevation in leads V1 through V4. What should you suspect?

Left anterior descending artery occlusion.

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of " breathing problem," for which he uses a prescribed inhaler and takes a "heart pill." You should suspect :

Left ventricular failure.

A 48 year old man with a history of hypertension presents with a severe headache, tinnitus, and blurred vision. He is conscious and alert and denies any other symptoms. His BP is 204/120 mm HG, his pulse rate is 100 beats/ min, and his oxygen saturation is 96% . The closest appropriate facility is 20 minutes away. You should:

Monitor his cardiac rhythm and transport.

You are assessing a conscious and alert middle-age male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm HG, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient's past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, lipitor, cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer?

Nitroglycerin

A 68 year old male who has COPD presents with edema to his feet and ankles, jugular venous distention, and an enlarged abdomen. What should you suspect?

Right ventricle failure

What 12- lead ECG finding should make you suspect a posterior STEMI?

ST depression in leads V1 and V2

When analyzing a cardiac rhythm strip in lead II, you should routinely evaluate all of the following components, EXCEPT the:

ST segment

A right ventricular infarction is characterized by:

ST-segment elevation greater than 1 mm in lead V4R and ST segment elevation in leads II, III and aVF.

Injury to the inferior wall of the myocardium would present with:

ST-segment elevation in leads II, III, and aVF.

A 39- year old man in asytole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on:

Searching for reversible causes.

Which of the following statements regarding second- degree heart block is correct?

Second- degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex.

Which of the following situations would contraindicate the administration of nitroglycerin?

The presence of right ventricular infarct

Which of the following statements regarding treatment for a first- degree heart block is correct?

Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.

Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct?

Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%.

Which of the following leads provides the BEST view of the anterolateral wall of the left ventricle?

V4 to V6

Which of the following differentiates an atrial rhythm from a sinus rhythm?

Varying shapes in P waves

On the 12- lead ECG, right atrial abnormality is characterized by:

a P wave amplitude greater than 1.5 mm in V1

Left Bundle Branch Block is characterized by:

a QRS greater than 120 milliseconds and a terminal s wave in V1.

Sinus arrest is characterized by:

a dropped PQRST complex.

Fibrinolysis may be contraindicated in all of the following, EXCEPT:

a history of anaphylactic shock caused by salicylates.

On the 12-lead ECG, extreme right axis deviation is characterized by:

a negative QRS in lead I and a negative QRS in lead aVF.

Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is:

a vasopressor.

The firing of the artificial ventricular pacemaker causes:

a vertical spike followed by a wide QRS complex

In addition to prompt transport, the goal of prehospital management for a patient with suspected aortic dissection includes:

adequate pain relief.

A wide QRS complex that is preceded by a normal P wave indicates:

an abnormality in ventricular conduction.

A hypertensive emergency is MOST accurately defined as:

an acute elevation in blood pressure with signs of end-organ damage.

A patient with right ventricular failure would most likely present with:

an enlarged liver.

sinus dysrhythmia is:

an irregular sinus rhythm.

When viewing leads V3 and V4, you are looking at the _________ wall of the _________.

anterior, left ventricle.

Acute coronary syndrome is a term used to describe:

any group of clinical symptoms consistent with acute myocardial ischemia.

The P wave represents:

atrial depolarization

Acetylcholinesterase is a naturally occurring chemical that:

breaks down acetylcholine in the body.

An electrical wave moving in the direction of a positive electrode will:

cause a positive deflection on the ECG.

A major complication associated with arterial fibrillation is:

clot formation in the fibrillating atria.

A decreased cardiac output secondary to a heart rate greater than 150 beats/ min is caused by:

decreases in stroke volume and ventricular filling.

The MOST important initial pieces if equipment to bring to the side of an unresponsive patient are the:

defibrillator and airway management equipment.

When assessing an anxious patient who presents with tachycardia, you must:

determine if the tachycardia is causing hemodynamic instability.

A first degree heart block has PR interval greater than 0.20 seconds because:

each impulse that reaches the AV node is delayed slightly longer than expected.

If a patient's ECG rhythm shows any artifact, you should:

ensure the electrodes are applied firmly on the skin.

Ventricular bigeminy occurs when:

every second complex is a PVC.

The most immediate forms of reperfusion therapy for an injured myocardium are:

fibrinolytics and percutaneous coronary intervention

Patients with Wolf-Parkinson-White syndrome:

have an accessory pathway that bypasses the AV node and causes early ventricular depolarization.

When administering aspirin to a patient with acute coronary syndrome, you should:

have him or her chew 160 to 325 mg of baby aspirin

If a patient's aortic aneurysm is not compressing on any adjacent structures:

he or she will likely be asymtomatic.

Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT:

headache

Common signs of left ventricular failure include all of the following, EXCEPT:

hypotension

The presence of a J wave (osborn wave) on the ECG is an indicator of :

hypothermia

The pain associated with pericarditis:

improves when the patient leans foward.

In a patient with left ventricular failure and pulmonary edema:

increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and in to the alveoli.

A prolonged PR interval:

indicates an abnormal delay at the AV node.

Jugular vein distention in a patient sitting at a 45 degree angle:

indicates right- sided heart compromise.

An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT:

irregular R-R intervals and a rate less than 40 beats/min.

Hypertension is present when blood pressure:

is consistently greater than 140/90 mm Hg while at rest.

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm:

is maximal from the onset.

Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of a(n):

ischemic stroke.

Lead I views the ________ wall of the heart, while lead aVF views the _________ wall of the heart.

lateral, Inferior

A patients 12- ECG shows qR complexes in leads I and aVL and rS complexes in leads II, III and aVF . This indicates :

left anterior fascicular block

A patient is considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for:

less than 12 hours

Fine ventricular fibrillation is characterized by fibrillatory waves that are:

less than 3 mm in amplitude.

If a paramedic must initiate drug therapy in the field for hypertensive encephalopathy, he or she should:

maintain the patient in the supine position.

A wandering pacemaker:

may have variable PR intervals.

Patients experiencing a right ventricular infarction:

may present with hypotension.

Patients who are experiencing an infarction of the right ventricle:

may present with significant hypotension

On the ECG graph paper, amplitude is measured in_____ and width is measured in _______.

millimeters, milliseconds

The brief pause between the P wave and QRS complex represents:

momentary conduction delay at the AV node.

Q waves are considered abnormal or pathologic if they are:

more than one-third the overall height of the QRS complex in lead II

sympathetic nerves are regulated primarily by:

norepinephrine

Non-ST Elevation Myocardial Infarction (NSTEMI)

not generally treated with cardiac catheterization.

Stable angina:

occurs after a predictable amount of exertion.

You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should:

perform asynchronous CPR while ventilating the patient at a rate of 10 breaths/min.

Hypertensive disease is characterized by:

persistent elevation of the diastolic pressure.

monomophic ventricular tachycardia:

presents with wide QRS complexes of a common shape

Abnormal neurologic signs that accompany hypertensive encephalopathy occur when:

pressure causes a breach in the blood- brain barrier and fluid leaks out, causing an increase in intracranial pressure.

Thousands of fibrils that are distributed throughout inner surfaces of the ventricles, which represent the end of the cardiac conduction system, are called the:

purkinje fibers

A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from:

rapid transport to an appropriate hospital.

You have just administered 0.4mg of sublingual nitroglycerin to a 60 year old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should :

reassess her blood pressure

Patients with a heart rate greater than 150 beats/ min usually become unstable because of:

reduced ventricular filling.

Bombardment of the AV node by more than one impulse, potentially blocking the pathway for one impulse and allowing the other impulse to stimulate cardiac cells that have already depolarized, is called:

reentry.

The QRS in lead I is a negative defection and the QRS in lead aVF is a positive deflection. This indicates:

right axis deviation

The inferior wall of the left ventricle is supplied by the:

right coronary artery

A 70- year old woman remains in asystole following 10 minutes of well- coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to:

seriously consider ceasing resuscitative efforts.

In which of the following situations is oxygen indicated for a patient who complains of chest pain, pressure or discomfort?

signs of heart failure are present.

A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a PR interval of 0.14 seconds, and QRS complexes that measure 0.10 seconds should be interpreted as:

sinus tachycardia

On the ECG strip, a third- degree AV block usually appears as a :

slow, wide QRS complex rhythm with inconsistent PR intervals.

Stimulation of the parasympathetic nervous system:

slows SA nodal discharge and decreases conduction through the AV node.

A delta wave is identified on a cardiac rhythm strip as a(n):

slurring of the upstroke of the first part of the QRS complex.

Which of the following clinical signs would you MOST likely observe in a patient with right ventriclar failure?

splenomegaly

The treatment for cardiogenic shock is generally focused on:

strengthening cardiac contractility without increasing the heart rate

During the refractory period:

the cell is depolarized or in the process of repolarizing.

Which of the following variables has the greatest impact on the efficacy of myocardial reperfusion therapy?

the duration from symptom onset to treatment

The Process of the aortic dissection begins with:

the intimal layer of the aortic wall is torn.

Under normal conditions, the strength of cardiac contraction is regulated by:

the nervous system.

A classic sign of atrial flutter is:

the presence of sawtooth F waves.

Anatomically contiguous leads view:

the same general area of the heart.

The recommended first-time treatment for third degree heart block associated with bradycardia and hemodynamic compromise is:

transcutaneous pacing.

Untreated ventricular tachycardia would MOST likely deteriorate to:

ventricular fibrillation.

Any electrical impulse that originates in the ventricles will produce:

wide QRS complexes and a rate between 20 and 40 beats/ min.

Premature ventricular complexes that originate from different sites in the ventricle:

will appear differently on the ECG.

In order to call a cardiac rhythm "paroxysmal" supraventricular tachycardia, you would have to:

witness it onset and/or spontaneous termination.

If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:

you should expect to see heart rates slower than 40 beats/min.