Acute Coronary Syndrome Flashcard 4
Rationale
D. Rationale: Stable angina is not one of the ACS groupings.
Question
Hospital personnel will categorize ACS patients into all of the following groups except:
a. STEMI
b. High-risk unstable angina
c. Non-ST elevation MI
d. Stable angina
Answer
d. Stable angina
Rationale
D. Rationale: Intravenous nitroglycerin relieves chest discomfort, pulmonary edema, and hypertension in patients with ischemic cardiac syndromes.
Question
In the emergency department, the attending physician orders IV nitroglycerin for a patient with acute coronary syndrome. What is the purpose of IV nitroglycerin in patients with ischemic cardiac syndromes?
a. To relieve chest discomfort
b. To treat pulmonary edema
c. To treat hypertension
d. All of the above
Answer
d. All of the above
Rationale
D. Rationale: The patient has a third-degree AV block—more P-waves than QRS complexes. The QRS complexes are wide, and the atrial and ventricular waves are regular but independent of each other. These patients are not responsive to the cholinergic effects of atropine. Emergency cardiovascular care guidelines suggest that transcutaneous pacing is preferred in this situation.
Question
In the emergency department, you record the following ECG tracing from a 33-year-old man that has recently fainted and is currently reporting chest pain:
Vital signs: HR 33 bpm, BP = 100/60 mm Hg, oxygen saturation = 97%. What is the most appropriate treatment of choice for this patient’s condition?
a. Synchronized cardioversion
b. Adenosine 6 mg IV bolus
c. Atropine 0.5 mg IV bolus
d. Transcutaneous pacing
Answer
d. Transcutaneous pacing
Rationale
B. Rationale: VF is most likely to develop during the first 4 hours after onset of symptoms.
Question
It is important that communities develop programs to address out-of-hospital cardiac arrest. About 50% of acute coronary syndrome patients die before they reach the hospital. Which of the following cardiac arrest rhythms is most likely to develop during the first 4 hours after the onset of symptoms?
a. Asystole
b. Ventricular fibrillation
c. Pulseless electrical activity
d. Pulseless ventricular tachycardia
Answer
b. Ventricular fibrillation
Rationale
D. Rationale: All of these are indications for the use of IV nitroglycerin in STEMI.
Question
IV nitroglycerin use in STEMI is indicated for:
A. Chest pain unresponsive to sublingual or spray nitroglycerin
B. STEMI complicated by pulmonary edema
C. STEMI complicated by hypertension
D. All of the above
Answer
D. All of the above
Rationale
C. Rationale: MACE stands for major adverse cardiac events. These events include nonfatal MI, death, and the need for urgent revascularization. Prevention of these events is one of the primary goals of therapy for patients with acute coronary syndrome (ACS). Other goals include reducing the amount of heart tissue death (preserving left ventricular function), preventing heart failure, and treating acute and life-threatening complications of ACS such as arrhythmias, cardiogenic shock, and pulmonary edema.
Question
MACE stands for:
A. Major arterial cannulation efforts
B. Minor alterations in cardiac effort
C. Major adverse cardiac events
D. Most advantageous coronary excursion
Answer
C. Major adverse cardiac events
Rationale
D. Rationale: Morphine is used for chest pain unresponsive to nitroglycerin. It causes venodilation.
Question
Morphine:
a. Is the first choice for reducing chest discomfort
b. Has an association with increased mortality in ACS
c. Causes dilation of the coronary arteries
d. Is used for chest pain unresponsive to nitroglycerin
Answer
d. Is used for chest pain unresponsive to nitroglycerin
Rationale
C. Rationale: If the patient has a systolic blood pressure < 90 mm Hg, an inferior wall STEMI, or has recently taken a phosphodiesterase-5 inhibitor (such as Viagra ™), then nitrates are contraindicated. (Acute Coronary Syndrome: Initial Pre-Hospital Therapies in ACS)
Question
Nitrates are contraindicated in patients with acute coronary syndrome in which of the following?
a. Systolic blood pressure > 90 mm Hg
b. Superior wall STEMI
c. Use of Viagra™ 6 weeks ago
d. Inferior wall MI
Answer
c. Use of Viagra™ 6 weeks ago
Rationale
D. Rationale: If the patient has a systolic blood pressure < 90 mm Hg, inferior wall STEMI, or has recently taken a phosphodiesterase-5 inhibitor (such as Viagra ™), then nitrates are contraindicated.
Question
Nitrates are contraindicated in patients with acute coronary syndrome who:
a. Have a systolic blood pressure < 90 mm Hg
b. Have an inferior wall STEMI
c. Recently took Viagra
d. All of the above
Answer
d. All of the above
Rationale
C. Rationale: In ACS, time is of the essence to prevent the progression to cardiac arrest or cardiac death. ED personnel are allotted 10 minutes to perform the initial assessment and management of these patients.
Question
Once a patient with suspected acute coronary syndrome arrives at the emergency department, how long is the allotted time for ED healthcare personnel to perform the initial emergency assessment and management of the patient?
a. 10 seconds
b. 2 minutes
c. 10 minutes
d. 90 minutes
Answer
c. 10 minutes