cardio Vol 3 Ch 2
The pericardial sac normally holds about ________ mL of ________.
25, straw-colored lubricant
The intrinsic firing rate of the AV node is ________ to ________ times per minute.
40, 60
The intrinsic rate of the AV node is:
40-60 bpm.
Brain natriuretic peptide (BNP) levels are useful in determining:
CHF
Which of the following most accurately differentiates cardioversion from defibrillation?
Cardioversion is timed to be synchronous with the patient's R wave.
A potassium level of 3.0 would commonly be associated with which ECG finding?
Flattening T wave
Which of the following is the correct sequence of cardiac electrical activity? 1. AV node 2. Internodal pathways 3. Bundle of His 4. SA node 5. Purkinje fibers 6. Bundle branches
4, 2, 1, 3, 6, 5
A pathological Q wave indicating infarction should measure:
0.04 seconds
One small box on the ECG paper indicates:
0.04 seconds
Normal interval time for the QRS complex is:
0.04-0.12 second.
Normal interval time for the PR interval is:
0.12-0.20 second.
One large box on the ECG paper indicates:
0.20 seconds
When the ECG paper is traveling at the standard rate of 25 mm/sec, a large box in the horizontal direction equals:
0.20 seconds
Life-threatening arrhythmias can result in death of the AMI patient as soon as:
1 hour after onset.
The intrinsic rate of the Purkinjie system is:
15-40 bpm
Your patient is a 32-year-old female, 30 weeks' pregnant, complaining of shortness of breath and palpitations. She is alert and oriented, though anxious; her skin is cool and moist, and her radial pulse is weak and rapid, but regular. HR = 180, BP = 100/72, RR = 24. The monitor shows supraventricular tachycardia. After applying oxygen by nonrebreather and starting an IV of normal saline, which of the following is most appropriate?
6 mg of adenosine
An accelerated junctional rhythm has a rate between ________ and ________.
60, 100
The intrinsic rate of the SA node is:
60-100
The loading dose of norepinephrine is:
8-10 mcg/min.
You are transporting a cardiac arrest when you achieve ROSC. You now want to keep the patient's systolic blood pressure in the range of:
80-100 mmHg.
Which of the following statements concerning Q waves on the ECG is most accurate?
A Q wave is significant if it is 0.04 or more seconds wide.
For a resting potential in a cardiac cell to exist, there must be an:
Adequate number of potassium ions inside the cell and sodium ions outside the cell
Increased ________ does NOT occur due to increased venous return to the heart.
Afterload
The amount of resistance that must be overcome by the left ventricle during systole is called:
Afterload
Which of the following most accurately describes a Valsalva maneuver?
Asking the patient to bear down as if to move his bowels with his nose and mouth closed
A 48-year-old male is complaining of chest pain that he describes as dull, located substernally, but radiating to his neck. He rates the pain a 6 on a scale of 1 to 10 and complains of nausea and lightheadedness. His skin is cool and diaphoretic. HR = 96, BP = 124/82, RR = 14, SaO2 = 97%. The 12-lead ECG is nondiagnostic. In addition to oxygen, an IV of normal saline at a keep open rate, and transport to the emergency department, which of the following would be most appropriate?
Aspirin, nitroglycerin, and morphine
Auscultation of an S3 is associated with:
Congestive heart failure
Beta-blockers generally have which of the following effects?
Decreased myocardial contractility
During which phase of the cardiac cycle does ventricular filling begin?
Diastole
The first phase of the cardiac cycle is:
Diastole
A 64-year-old female is alert and oriented, in moderate respiratory distress, and complaining of chest pain. She describes an acute onset of right-sided chest pain that radiates across her chest. Physical examination reveals cold, diaphoretic skin; lung sounds with crackles bilaterally; JVD; and peripheral edema. Medical history includes hypertension, prior myocardial infarction, and heart failure. HR = 128, BP = 86/56, RR = 26, SaO2 = 92%. Which of the following is appropriate in the prehospital treatment of this patient?
Dopamine
You have begun transcutaneous pacing of a 52-year-old male who is in third-degree heart block. He was initially unresponsive to all stimuli, with a pulse of 32, blood pressure 60 by palpation, and a respiratory rate of 12. Which of the following is LEAST helpful when determining the effectiveness of transcutaneous pacing?
Evidence of electrical capture
Which of the following is the LEAST likely cause of PEA?
Hypertension
Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate?
Immediate synchronized cardioversion
If the stroke volume decreased, which of the following would occur to maintain the blood pressure at its current value?
Increased heart rate and increased peripheral vascular resistance
Which of the following is the most likely result of increased pulmonary artery pressure?
Increased right ventricular workload and cor pulmonale
A 35-year-old male is complaining of a headache, blurred vision, nausea, and vomiting. He has a history of hypertension but is noncompliant with his medications. His pupils are equal and reactive, his skin is warm and dry, and his breath sounds are clear and equal bilaterally. HR = 122, BP = 202/138, RR = 12, SaO2 = 99%. In addition to monitoring his cardiac rhythm, administering oxygen, and starting an IV at a KVO rate, which of the following is most appropriate?
Labetalol, IV
The mitral valve is also known as the ________ valve
Left atrioventricular
PSVT is LEAST likely to occur secondary to:
Myocardial infarction
Release of acetylcholine at the neuroeffector junction would result in a(n):
Negative chronotropic effect
Which of the following has NOT been proven to increase the risk of cardiovascular disease?
Obesity
A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO2 = 92%. Which of the following should be done first?
Oxygen by nonrebreathing mask
Atrial depolarization is represented on the ECG by the:
P wave.
Which of the following ECG findings would indicate a possible pacemaker failure?
Pacemaker spikes without associated QRS complexes
Signs and/or symptoms of a dissecting thoracic aneurysm include all of the following EXCEPT:
Palpable pulsating mass
Diaphoresis exhibited in a patient actively having an MI is due to:
sympathetic response
The right ventricle pushes blood to the lungs through the:
Pulmonary Artery
Which of the following is most commonly associated with multifocal atrial tachycardia?
Pulmonary disease
Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88. The patient is experiencing:
Pulse deficit
________ is a drop in systolic blood pressure of more than 10 mmHg with inspiration.
Pulsus paradoxus
Ventricular depolarization is represented on the ECG by the:
QRS complex
The total duration of ventricular depolarization is represented by the ________ on the ECG.
QT interval
Measures to treat cardiogenic shock include all of the following EXCEPT:
Reducing stroke volume
The SA and AV nodes are often supplied by both the ________ and ________ arteries.
Right coronary, circumflex coronary
Which of the following is NOT a phase of cardiac arrest?
Rigor mortis phase
Public education about cardiovascular disease focuses on:
Risk factors and signs and symptoms of CVD
The heart sound produced by the closing of the aortic and pulmonary valves is:
S2
Myocardial ischemia may result in:
ST segment depression
Treatment of sinus tachycardia is aimed at:
treating the underlying cause
Your patient is a 55-year-old male who is in moderate distress and complaining of chest pain. He states that he experienced an acute onset of left-sided crushing chest pain while playing basketball with his grandson. He complains of weakness and near-syncope with exertion. His skin is pale, cool, and diaphoretic. HR = 40, BP = 72/40, RR = 20, SaO2 = 95%. The monitor shows a third-degree AV block. Which of the following is most appropriate?
Sedation and transcutaneous pacing
While monitoring a patient's cardiac rhythm, you note that there is no electrical activity after a PQRST complex for a period equal to exactly three of the previous R-R intervals. This is most accurately described as:
Sinus Block
A patient's ECG shows regular RR intervals of 0.48 seconds, a PR interval of 0.12 seconds, and a QRS of 0.08 seconds. This best fits the criteria for:
Sinus Tachycardia
Which of the following rhythms requires transcutaneous pacing?
Symptomatic third-degree AV block
Ventricular repolarization is represented on the ECG by the:
T wave
A potassium level of 8.0 would commonly be associated with which ECG finding?
T wave merging with QRS
Which of the following occurs during depolarization of a cardiac cell?
The cell becomes relatively more positively charged.
A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following?
The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle.
You are transporting a patient who is having wild changes in his heart rate, an irregular R-R interval, and a history of taking lanoxin. The patient is now becoming pale, cool, and clammy, with an MAP of 60. You should:
begin TCP and consider a catecholamine infusion.
Typical stroke volume is about ________ of the volume of the left ventricle.
two-thirds
On an ECG tracing, positive impulses are seen as:
upward deflections.
ECG findings associated with hypokalemia include:
U waves and flat T waves
The five-step procedure for analyzing ECGs includes all of the following EXCEPT:
V1
The anterior surface of the heart is best viewed by ECG leads:
V1-V4
The lead to the left of the sternum at the fourth intercostal space is:
V2
The QRS complex represents:
Ventricular depolarization
Common chief complaints and symptoms associated with cardiac disease include all of the following EXCEPT
Vertigo
Excessive preload over time would lead to:
Weakening of the Left Ventricle
Your patient is a 54-year-old male who is unresponsive and cyanotic and has agonal respirations. A "quick look" shows ventricular tachycardia. Which of the following is most important when determining the immediate treatment of this patient?
Whether he has a pulse
Sudden death is described as:
any death occurring within 1 hour of onset of symptoms.
The first part of the aorta as it leaves the heart is the:
ascending aorta
Cardiac output is:
stroke volume x heart rate.
You have been on the scene of a 55-year-old cardiac arrest patient for 30 minutes. You have full ALS care initiated, with no response to therapy. You should:
consider termination of the arrest
Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock include all of the following EXCEPT:
constricted pupils
The single largest killer of Americans each year is:
coronary artery disease.
Poiseuille's law specifically states that blood flow through a vessel is directly proportional to the ________ of the vessel's radius.
fourth power
You have administered a drug with potent beta-1 effects. Which of the following effects should you most anticipate?
increased heart rate
Your patient is found sitting on the edge of the bathtub with cool, diaphoretic skin. She states she became lightheaded and nearly "passed out" while vomiting. Your cardiac monitor shows a sinus bradycardia at a rate of 48. Which of the following is most likely?
increased parasympathetic tone
You run a 12-lead ECG on a patient exhibiting chest pain. It reveals ST segment elevation in leads II, III, and AVF, with reciprocal in leads AVL and I. You suspect:
inferior MI.
A 67-year-old male is unconscious, is sitting in a chair, and has agonal respirations. His wife states that he was up all night with difficulty breathing and chest discomfort but would not go to the hospital. Physical examination reveals pink, frothy sputum in the airway; cold, diaphoretic skin; and rales audible without a stethoscope. HR = 108, BP = 74 mmHg by palpation, RR = 4, SaO2 = 82%. The monitor shows sinus tachycardia. Which of the following is the highest priority when treating this patient?
intubation
Your patient goes into polymorphic V-tach. Your primary pharmacological agent is:
magnesium sulfate, 1-2 gm
The left atrioventricular valve is referred to as the ________ valve.
mitral
An elevation of the ST segment is associated with:
myocardial injury
The presence of inverted T waves on an ECG indicates:
myocardial ischemia
To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s).
one
Which of the following ECG findings is LEAST anticipated in a patient experiencing an acute myocardial infarction?
osborn wave
Myocardial ischemia is caused by an imbalance of:
oxygen supply and demand.
The pressure in the left ventricle at the end of diastole is called:
preload
The pressure in the ventricle at the end of diastole is called:
preload.
You are called for a patient experiencing SOB. The patient is also a diabetic, so you preform a 12-lead ECG. It shows ST segment elevation in leads V1, V2, V3, and V4 with reciprocal changes in leads V5, V6, II, III, and AVF. You suspect:
septal-anterior MI
Blood pressure is defined as:
stroke volume times heart rate times SVR.
