Paramedic Chapter 18 Cardiovascular Emergencies

C

All of the following are strategies for decreasing the risk for cardiovascular disease, EXCEPT:

A) smoking cessation.

B) lipid management.

C) anaerobic exercise.

D) behavior modification.

A

The heart's anatomic location is MOST accurately described as being:

A) retrosternal.

B) hemithoracic.

C) submediastinal.

D) supradiaphragmatic.

D

The point of maximal impulse usually can be felt on the:

A) medial aspect of the chest, just below the third intercostal space.

B) left lateral chest, in the midaxillary line, at the fourth intercostal space.

C) left anterior chest, in the midaxillary line, at the fifth intercostal space.

D) left anterior chest, in the midclavicular line, at the fifth intercostal space.

A

The layers of the wall of the heart, beginning with the outermost layer, are the:

A) epicardium, myocardium, and endocardium.

B) endocardium, epicardium, and myocardium.

C) myocardium, epicardium, and endocardium.

D) epicardium, endocardium, and myocardium.

B

The left main coronary artery subdivides into the:

A) left anterior ascending and descending arteries.

B) left anterior descending and circumflex arteries.

C) left posterior ascending and circumflex arteries.

D) right coronary and left posterior descending arteries.

D

The right atrium, right ventricle, and part of the left ventricle are supplied by the:

A) circumflex artery.

B) left anterior descending artery.

C) left main coronary artery.

D) right coronary artery.

C

The numerous connections among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery begins to narrow, are called:

A) cardiac myocytes.

B) the coronary sinus.

C) collateral circulation.

D) coronary microcirculation.

D

What prevents the backflow of blood during ventricular contraction?

A) The aortic valve

B) Semilunar valves

C) The pulmonic valve

D) AV valves

B

Injury to or disease of the ______________ may cause prolapse of a cardiac valve leaflet, allowing blood to regurgitate from the ventricle into the atrium.

A) coronary sulcus

B) chordae tendineae

C) interatrial septum

D) coronary sinus

A

The mitral valve:

A) is located on the higher-pressure side of the heart.

B) separates the right atrium from the right ventricle.

C) prevents blood regurgitation into the left ventricle.

D) is a tricuspid valve located on the right side of the heart.

A

The S1 heart sound represents:

A) closure of the mitral and tricuspid valves.

B) the end of ventricular contraction.

C) closure of the aortic and pulmonic valves.

D) the beginning of atrial contraction.

C

A loud S3 heart sound, when heard in older adults, often signifies:

A) emphysema.

B) valve rupture.

C) heart failure.

D) pulmonary hypertension.

B

Approximately 80% of ventricular filling occurs:

A) during systole.

B) during diastole.

C) when the semilunar valves are open.

D) when the AV valves close.

D

Atrial kick is defined as:

A) the blood that flows passively into the ventricles.

B) pressure on the AV valves during ventricular contraction.

C) an attempt of the atria to contract against closed valves.

D) increased preload pressure as a result of atrial contraction.

B

Which of the following statements regarding the right side of the heart is correct?

A) It receives blood exclusively from the venae cavae.

B) The right side of the heart is a low-pressure pump.

C) It pumps against the high resistance of the pulmonary circulation.

D) The right side of the heart pumps blood through the pulmonary veins.

A

In contrast to the right side of the heart, the left side of the heart:

A) drives blood out of the heart against the relatively high resistance of the systemic circulation.

B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs.

C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.

D) drives blood out of the heart against the relatively low resistance of the pulmonary

A

Which part of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility?

A) Tunica media

B) Tunica intima

C) Tunica adventitia

D) Arterial lumen

C

In contrast to arteries, veins:

A) do not contain valves that prevent backflow of blood.

B) have less capacity to increase the size of their diameter.

C) are more likely to distend when exposed to backpressure.

D) operate on the high-pressure side of the circulatory system.

B

The amount of blood that is pumped out by either ventricle per minute is called:

A) ejection fraction.

B) cardiac output.

C) stroke volume.

D) minute volume.

D

If the left ventricle contains 80 mL of blood before a contraction and ejects 60 mL during the contraction, the ejection fraction is:

A) 60%.

B) 65%.

C) 70%.

D) 75%.

C

Cardiac output is influenced by:

A) heart rate.

B) stroke volume.

C) heart rate and/or stroke volume.

D) ejection fraction and heart rate.

A

If an increased amount of blood is returned to the heart:

A) the cardiac muscle must stretch to accommodate the larger volume.

B) stroke volume decreases accordingly because of the larger volume.

C) an increase in stroke volume occurs because the heart rate increases.

D) cardiac workload is decreased, resulting in a decreased cardiac output.

A

The ability of the heart to vary the degree of its contraction without stretching is called:

A) contractility.

B) chronotropy.

C) automaticity.

D) the Frank-Starling mechanism.

B

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

A) the heart rate.

B) the nervous system.

C) physical exertion.

D) the Frank-Starling mechanism.

D

Administering a drug that possesses a positive chronotropic effect will have a direct effect on:

A) stroke volume.

B) blood pressure.

C) cardiac output.

D) the heart rate.

C

Changes in cardiac contractility may be induced by medications that have a positive or negative ___________ effect.

A) vasoactive

B) dromotropic

C) inotropic

D) chronotropic

C

Automaticity is defined as the ability of the heart to:

A) generate an electrical impulse from the same site every time.

B) spontaneously conduct an electrical impulse between cardiac cells.

C) generate its own electrical impulses without stimulation from nerves.

D) increase or decrease its heart rate based on the body's metabolic needs.

B

The area of conduction tissue in which electrical activity arises at any given time is called the:

A) myocyte.

B) pacemaker.

C) sinus node.

D) bundle of His.

A

Which of the following statements regarding the SA node is correct?

A) The SA node is the dominant cardiac pacemaker in healthy patients.

B) SA nodal ischemia occurs when the left coronary artery is occluded.

C) The SA node is located in the superior aspect of the right ventricle.

D) Impulses generated by the SA node travel through the right atrium only.

D

The AV junction:

A) includes the AV node but not the bundle of His.

B) is the dominant and fastest pacemaker in the heart

C) receives its blood supply from the circumflex artery.

D) is composed of the AV node and surrounding tissue.

D

An electrical impulse is slightly delayed at the AV node so that the:

A) bundle of His can depolarize fully.

B) ventricles can contract completely.

C) primary cardiac pacemaker can reset.

D) atria can empty into the ventricles.

B

The effect on the velocity of electrical conduction is referred to as the _________ effect.

A) inotropic

B) dromotropic

C) chronotropic

D) conductivity

C

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

A) bundle branches.

B) internodal pathways.

C) Purkinje fibers.

D) cardiac myocytes.

A

Depolarization, the process by which muscle fibers are stimulated to contract, occurs when:

A) cell wall permeability changes and sodium rushes into the cell.

B) calcium ions rapidly enter the cell, facilitating contraction.

C) potassium ions escape from the cell through specialized channels.

D) cardiac muscle relaxes in response to a cellular influx of calcium.

A

Repolarization begins when:

A) the sodium and calcium channels close.

B) calcium ions slowly enter the cardiac cell.

C) potassium ions rapidly escape from the cell.

D) the inside of the cell returns to a positive charge.

D

In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump:

A) moves three sodium ions and three potassium ions back into the cell.

B) moves two sodium ions into the cell for every three potassium ions it moves out of the cell.

C) moves calcium and potassium ions back into the cell by a process called passive transport.

D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.

A

Hypomagnesemia would MOST likely result in:

A) decreased cardiac conduction.

B) decreased myocardial irritability.

C) a decrease in cardiac contractility.

D) decreased myocardial automaticity.

B

Which of the following electrolytes maintains the depolarization phase?

A) Sodium

B) Calcium

C) Potassium

D) Magnesium

C

During the refractory period:

A) the heart is in a state of partial repolarization.

B) the heart is partially charged, but cannot contract.

C) the cell is depolarized or in the process of repolarizing.

D) the heart muscle is depleted of energy and needs to recharge.

B

The SA node:

A) cannot depolarize faster than 100 times/min.

B) will outpace any slower conduction tissue.

C) functions as the heart's secondary pacemaker.

D) has an intrinsic firing rate of 40 to 60 times per minute.

A

The farther removed the conduction tissue is from the SA node:

A) the slower its intrinsic rate of firing.

B) the longer the PR interval will be.

C) the faster its intrinsic rate of firing.

D) the narrower the QRS complex will be.

D

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

A) the AV junction will begin pacing at 40 to 60 times/min.

B) you will see a brief period of bradycardia followed by asystole.

C) the P wave and PR interval will have an abnormal appearance.

D) you should expect to see a heart rate slower than 40 beats/min.

B

The P wave represents:

A) SA nodal discharge.

B) atrial depolarization.

C) a delay at the AV node.

D) contraction of the atria.

D

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

A) depolarization of the inferior part of the atria.

B) the period of time when the atria are repolarizing.

C) full dispersal of electricity throughout both atria.

D) a momentary conduction delay at the AV junction.

C

Which of the following ECG waveforms represents ventricular depolarization?

A) T wave

B) ST segment

C) QRS complex

D) U wave

A

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

A) 0.12, 0.20

B) 0.14, 0.30

C) 0.16, 0.40

D) 0.18, 2.0

A

Normally, the ST segment should be:

A) at the level of the isoelectric line.

B) elevated by no more than 1 mm.

C) depressed by no more than 2 mm.

D) invisible on a normal ECG tracing.

D

Stimulation of the parasympathetic nervous system:

A) completely blocks the AV node, preventing ventricular depolarization.

B) causes a decrease in the production of epinephrine and norepinephrine.

C) is characterized by a large P wave and a PR interval that is shorter than normal.

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

B

Cholinesterase is a naturally occurring chemical that:

A) increases epinephrine production.

B) regulates acetylcholine in the body.

C) stimulates activity of the vagus nerve.

D) causes a natural slowing of the heart rate.

C

Stimulation of the parasympathetic nervous system causes all of the following effects, EXCEPT:

A) negative inotropy.

B) increased salivation.

C) dilation of the pupils.

D) negative chronotropy.

B

Unlike the parasympathetic nervous system, the sympathetic nervous system:

A) is not under the direct control of the autonomic nervous system.

B) provides a mechanism for the body to adapt to changing demands.

C) is blocked when drugs such as atropine are administered.

D) constricts the pupils and increases gastrointestinal function when stimulated.

A

A physiologic effect of sympathetic nervous stimulation includes:

A) dilation of the bronchioles.

B) decreased conduction velocity.

C) a negative dromotropic effect.

D) dilation of the blood vessels.

D

Sympathetic nerves are regulated primarily by:

A) adrenaline.

B) epinephrine.

C) cholinesterase.

D) norepinephrine.

D

Which of the following chemicals or drugs causes an increase in heart rate?

A) Norepinephrine

B) Cholinesterase

C) Atenolol and neostigmine

D) Atropine and epinephrine

D

Stimulation of alpha and beta receptors affects the:

A) heart only.

B) heart and blood vessels.

C) blood vessels and lungs.

D) heart, lungs, and blood vessels.

C

Vasoconstriction occurs following stimulation of:

A) beta-1 receptors.

B) beta-2 receptors.

C) alpha receptors.

D) alpha and beta receptors.

B

Drugs that have alpha or beta sympathetic properties are called:

A) vagolytics.

B) sympathomimetics.

C) parasympatholytics.

D) adrenergic blockers.

A

To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:

A) stimulates beta-1 and beta-2 receptors.

B) stimulates beta-2 and alpha receptors.

C) blocks beta-1 and beta-2 receptors.

D) blocks beta receptors and stimulates alpha receptors.

A

A pure alpha agent:

A) causes marked vasoconstriction.

B) has a direct effect on the heart rate.

C) causes moderate bronchoconstriction.

D) decreases the blood pressure by dilating the vessels.

C

Which of the following drugs possesses beta-2-specific properties?

A) Dopamine

B) Levophed

C) Proventil

D) Epinephrine

A

A beta adrenergic blocker would counteract all of the following medications, EXCEPT:

A) atropine.

B) epinephrine.

C) isoproterenol.

D) norepinephrine.

D

Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation?

A) Dopamine

B) Propranolol

C) Isoproterenol

D) Norepinephrine

B

Epinephrine is used to treat patients in anaphylactic shock because of its effects of:

A) vasodilation and bronchoconstriction.

B) bronchodilation and vasoconstriction.

C) increased heart rate and automaticity.

D) parasympathetic nervous system blockade.

C

The MOST effective drug for the treatment of non-vagal-induced bradycardia is:

A) atropine.

B) dopamine.

C) epinephrine.

D) metoprolol.

D

Which of the following drugs is contraindicated in patients with asthma?

A) Albuterol

B) Adrenaline

C) Norepinephrine

D) Propranolol

A

An increase in peripheral vascular resistance causes:

A) an increase in afterload.

B) a decrease in blood pressure.

C) an increase in cardiac output.

D) a decrease in cardiac workload.

A

If you are unsure whether a conscious cardiac patient requires immediate transport versus continued assessment at the scene, you should:

A) continue with the secondary assessment to obtain more information.

B) take the patient's vital signs and then make your transport decision.

C) begin immediate transport and perform a focused assessment en route.

D) contact medical control and inform him or her of the patient's condition.

B

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

A) fatigue.

B) headache.

C) chest pain.

D) palpitations.

C

Cardiac-related chest pain is often palliated by:

A) stress.

B) exertion.

C) nitroglycerin.

D) mild exercise.

D

Paroxysmal nocturnal dyspnea is defined as:

A) dyspnea that is brought on by excessive movement during sleep.

B) sitting upright in a chair in order to facilitate effective breathing.

C) the inability to function at night due to severe difficulty breathing.

D) acute shortness of breath that suddenly awakens a person from sleep.

C

A patient with orthopnea:

A) experiences dyspnea during periods of exertion.

B) prefers a semisitting position to facilitate breathing.

C) experiences worsened dyspnea while lying down.

D) sleeps in a recliner due to severe right heart failure.

B

In the context of cardiac compromise, syncope occurs due to:

A) an increase in vagal tone.

B) a drop in cerebral perfusion.

C) a sudden cardiac dysrhythmia.

D) an acute increase in heart rate.

A

Which of the following underlying medical conditions would be of LEAST pertinence when obtaining the past medical history from a patient who complains of acute chest pain or pressure?

A) Cancer

B) Diabetes

C) Renal disease

D) Hypertension

B

A pulse that alternates in strength from one beat to the next beat is called:

A) pulse deficit.

B) pulsus alternans.

C) pulsus paradoxus.

D) paradoxical pulse.

B

Which of the following medications is a calcium channel blocker?

A) Lanoxin

B) Cardizem

C) Tenormin

D) Capoten

D

A patient with a medical condition that requires antiplatelet therapy would MOST likely be taking:

A) Coreg.

B) Altace.

C) Zocor.

D) Plavix.

C

Spironolactone is a(n):

A) beta blocker.

B) vasodilator.

C) diuretic.

D) antiarrhythmic.

D

Which of the following medications has a direct blood-thinning effect?

A) Plavix

B) Aspirin

C) Accupril

D) Warfarin

B

A patient with an elevated cholesterol level would MOST likely take:

A) Inderal.

B) Altacor.

C) Isordil.

D) Diovan.

A

When reviewing a cardiac patient's medication list, you note that she is taking bisoprolol. You recognize that this drug is also called _____________ and is classified as a(n) _____________.

A) Zebeta, beta blocker

B) Betapace, antiarrhythmic

C) Ticlid, antiplatelet agent

D) Norvasc, calcium channel blocker

A

All of the following medications are angiotensin II receptor blockers, EXCEPT:

A) Niaspan.

B) Diovan.

C) Avapro.

D) Atacand.

C

Which of the following blood pressure readings is MOST suggestive of a patient who has arteriosclerosis?

A) 140/90 mm Hg

B) 150/80 mm Hg

C) 160/70 mm Hg

D) 180/110 mm Hg

B

Which of the following conditions would MOST likely cause the blood pressure to vary between the left arm and right arm?

A) Cor pulmonale

B) Aortic aneurysm

C) Left heart failure

D) Cardiac tamponade

D

Jugular venous distention in a patient sitting at a 45° angle:

A) is not clinically significant.

B) is a sign of reduced preload.

C) suggests left-sided heart failure.

D) indicates right-sided heart compromise.

B

When examining the chest of a patient who has an automated implanted cardioverter defibrillator, you would MOST likely find it:

A) just below the xiphoid process.

B) below the left or right clavicle.

C) in the lower aspect of the chest.

D) just lateral to the lower sternum.

B

Which of the following clinical findings is LEAST suggestive of left-sided heart failure?

A) An S3 gallop

B) Sacral edema

C) Crackles in the lungs

D) Shortness of breath

A

Myocardial ischemia occurs when the heart muscle:

A) is deprived of oxygen because of a blocked coronary artery.

B) undergoes necrosis because of prolonged oxygen deprivation.

C) suffers oxygen deprivation secondary to coronary vasodilation.

D) experiences a decreased oxygen demand and an increased supply.

C

Atherosclerosis is a process in which:

A) the outer wall of a coronary artery becomes lined with masses of fatty tissue.

B) calcium precipitates into the arterial walls, greatly reducing the artery's elasticity.

C) plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen.

D) plaque ruptures from a distant location and lodges in one of the coronary arteries.

D

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

A) A bruit heard over the carotid artery

B) Pain in the calf muscle while walking

C) Swelling and pain along the course of a vein

D) An S3 sound during auscultation of the heart

C

Acute coronary syndrome is a term used to describe:

A) acute chest pressure or discomfort that subsides with rest or nitroglycerin.

B) a clinical condition in which patients experience chest pain during exertion.

C) any group of clinical symptoms consistent with acute myocardial ischemia.

D) a sudden cardiac rhythm disturbance that causes a decrease in cardiac output.

A

Most patients with an ST-elevation myocardial infarction:

A) will develop Q waves.

B) heal without treatment.

C) experience cardiac arrest.

D) present without chest pain.

B

Stable angina:

A) typically subsides within 10 to 15 minutes.

B) occurs after a predictable amount of exertion.

C) usually requires both rest and nitroglycerin to subside.

D) is characterized by sharp chest pain rather than pressure.

B

In contrast to stable angina, unstable angina:

A) occurs following periods of strenuous exertion.

B) often awakens the patient from his or her sleep.

C) indicates that myocardial necrosis has occurred.

D) is less frequent but is associated with more pain.

D

Which of the following MOST accurately describes an acute myocardial infarction?

A) Death of the myocardium secondary to spasm of a major coronary artery

B) Injury to a portion of the heart muscle secondary to atherosclerotic disease

C) Damage to the left ventricle following occlusion of the left coronary artery

D) Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

C

Infarctions of the inferior myocardial wall are MOST often caused by:

A) blockage of the left coronary artery.

B) acute spasm of the circumflex artery.

C) occlusion of the right coronary artery.

D) a blocked left anterior descending artery.

A

Cardiac arrhythmias following an acute myocardial infarction:

A) tend to originate from ischemic areas around the infarction.

B) typically manifest as atrial fibrillation or atrial tachycardia.

C) generally originate from the center of the infarcted tissues.

D) are uncommon within the first 24 hours after the infarction.

C

The Levine sign is defined as:

A) pushing on the sternum with the fingertips.

B) rubbing the arm to which pain is radiating.

C) a subconsciously clenched fist over the chest.

D) a state of denial in patients with an acute myocardial infarction.

B

The pain associated with an acute myocardial infarction:

A) radiates to the left or right arm in the majority of cases.

B) is not influenced by deep breathing or body movement.

C) is most often described as a sharp sensation in the chest.

D) is often relieved by two or three doses of sublingual nitroglycerin.

B

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

A) 49-year-old obese man

B) 58-year-old diabetic woman

C) 60-year-old man with anxiety

D) 71-year-old woman with hypertension

D

The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:

A) fear and anxiety.

B) the effects of nitroglycerin.

C) acute left-sided heart failure.

D) a reduction in cardiac output.