PCCN Cardiovascular Exam Questions With Accurate
Answers.
Unstable Angina - accurate answers-Change in the pattern of angina;
Increased pain; not responsive to first Nitro tab; Can persist >5 min; Occurs
more Freq; lasts longer; Occurs at rest --> Indicates Rupture of plaque forming
thrombus = MI
Variant Angina - accurate answers-Results from spasms of the Coronary
arteries (c) or (s) plaque; r/t smoking/etoh/stimulant rxs; elevated STs;
usually occurs at same time each day; occurs at rest --> Tx with Nitro & Ca++
Ch Blockers
Calcium Channel Blocker - accurate answers-Blocks Ca+ flow = Decreased
Contraction + Decreased Conductivity = Decreased Demand for O2 --> Tx for
angina & arrhythmias.
-- Side Fx = Decreased BP, Brady<3, Poss AV block, HA, nausea, poss perph
edema
Myocardial Infarction - accurate answers-Hearts Demand for O2 > Supply of
O2 - usually from ACS (plaque or thrombus) - Can also come from
vasoconstriction/acute blood loss/decreased O2/cocaine - Usually occurs in
stages.
Zone of Infarction - accurate answers-Area of tissue necrosis = cells destroyed
and replaced with scar tissue/ irreversible damage happens after complete
occlusion for 15-20 mins
Q-wave MI - accurate answers-Wider and deeper abnormal Qwaves especially
in the early am (because of adrenergic activity); Infarction prolonged & turns
into necrosis
- Indicates transmural necrosis in most cases from coronary complete
occlusion (80%-90%) - Mortality in 10% of cases.
Non-Q-wave MI - accurate answers-ST depressions and reversible within a
few days; reperfusion occurs spontaneously so infarct size is smaller;
contraction necrosis & scarring from extra contraction for reperfusion
common; complete coronary occlusion in only (20%-30%) - Mortality in only
2%-3% of cases - Most likely will have another MI in 2 years.
, MI Symptoms - accurate answers-Crushing CP - may radiate; palpitations;
HTN or HypoTN; EKG changes; Dyspnea/SOB; Pulm edema; N+V; decreased
urinary output; clammy/pale/cold; dependent edema; Change in LOC
MI Labs - accurate answers-- ECG = St elevation or Wide Qwave
- CK = peaks in 24 hrs for Qwave MI; peaks 12 hrs for non-Qwave MI
- Myoglobin = heme protein that carries O2 - no increase = not an MI
- Troponin = Can remain elevated for 3 weeks
Papillary Muscle Rupture - accurate answers-Direct result from MI = When
the muscles that control the atria/vent valves (TV and MV) rupture =
regurgitation or dysfxn; leads to vent failure due to backflow; MV regurg can
lead to pulm efema and cardiogenic shock - diagnose with ECHO.
Myocarditis - accurate answers-Inflammation of <3 muscle - usually from
infection. --> leads to a Dilated HF - May be too problematic in the future. -
fatigue easily, CP, dyspnea; discomfort; palpitations
MI: Diagnose & Treat - accurate answers-Dx: Chest Xray, Echo, ECG, Cath lab,
Blood Cxs.
Tx: IVabx (bact/viral), restrict activities, cardiac monitoring, CHF tx (<3 meds
and diurese), O2 sup, monitor.
Pericarditis - accurate answers-Inflammation of the membrane around the
heart; Outer layers is meant to protect and anchor the heart; Inner layer helps
lubricate the heart; Infection = layers stick to eachother with pus;
- S+S = fever, dysrhythmia, poor app, arritability; malaise; sharp piercing CP
Pericarditis: Diagnose & Treat - accurate answers-Dx: Chest Xray, Echo, ECG,
Cath lab, Blood Cxs.
Tx: Pain Control, Anti inflammatory rx for pain & fluid reabsorption, Restrict
Activity, Corticosteroids if no response to antiinflams
- May need surgical intervention if fluid in pericardial sac is increasing
pressure on heart.
- If severe, outer layer of Pericardium if preventing vent fxn.
Answers.
Unstable Angina - accurate answers-Change in the pattern of angina;
Increased pain; not responsive to first Nitro tab; Can persist >5 min; Occurs
more Freq; lasts longer; Occurs at rest --> Indicates Rupture of plaque forming
thrombus = MI
Variant Angina - accurate answers-Results from spasms of the Coronary
arteries (c) or (s) plaque; r/t smoking/etoh/stimulant rxs; elevated STs;
usually occurs at same time each day; occurs at rest --> Tx with Nitro & Ca++
Ch Blockers
Calcium Channel Blocker - accurate answers-Blocks Ca+ flow = Decreased
Contraction + Decreased Conductivity = Decreased Demand for O2 --> Tx for
angina & arrhythmias.
-- Side Fx = Decreased BP, Brady<3, Poss AV block, HA, nausea, poss perph
edema
Myocardial Infarction - accurate answers-Hearts Demand for O2 > Supply of
O2 - usually from ACS (plaque or thrombus) - Can also come from
vasoconstriction/acute blood loss/decreased O2/cocaine - Usually occurs in
stages.
Zone of Infarction - accurate answers-Area of tissue necrosis = cells destroyed
and replaced with scar tissue/ irreversible damage happens after complete
occlusion for 15-20 mins
Q-wave MI - accurate answers-Wider and deeper abnormal Qwaves especially
in the early am (because of adrenergic activity); Infarction prolonged & turns
into necrosis
- Indicates transmural necrosis in most cases from coronary complete
occlusion (80%-90%) - Mortality in 10% of cases.
Non-Q-wave MI - accurate answers-ST depressions and reversible within a
few days; reperfusion occurs spontaneously so infarct size is smaller;
contraction necrosis & scarring from extra contraction for reperfusion
common; complete coronary occlusion in only (20%-30%) - Mortality in only
2%-3% of cases - Most likely will have another MI in 2 years.
, MI Symptoms - accurate answers-Crushing CP - may radiate; palpitations;
HTN or HypoTN; EKG changes; Dyspnea/SOB; Pulm edema; N+V; decreased
urinary output; clammy/pale/cold; dependent edema; Change in LOC
MI Labs - accurate answers-- ECG = St elevation or Wide Qwave
- CK = peaks in 24 hrs for Qwave MI; peaks 12 hrs for non-Qwave MI
- Myoglobin = heme protein that carries O2 - no increase = not an MI
- Troponin = Can remain elevated for 3 weeks
Papillary Muscle Rupture - accurate answers-Direct result from MI = When
the muscles that control the atria/vent valves (TV and MV) rupture =
regurgitation or dysfxn; leads to vent failure due to backflow; MV regurg can
lead to pulm efema and cardiogenic shock - diagnose with ECHO.
Myocarditis - accurate answers-Inflammation of <3 muscle - usually from
infection. --> leads to a Dilated HF - May be too problematic in the future. -
fatigue easily, CP, dyspnea; discomfort; palpitations
MI: Diagnose & Treat - accurate answers-Dx: Chest Xray, Echo, ECG, Cath lab,
Blood Cxs.
Tx: IVabx (bact/viral), restrict activities, cardiac monitoring, CHF tx (<3 meds
and diurese), O2 sup, monitor.
Pericarditis - accurate answers-Inflammation of the membrane around the
heart; Outer layers is meant to protect and anchor the heart; Inner layer helps
lubricate the heart; Infection = layers stick to eachother with pus;
- S+S = fever, dysrhythmia, poor app, arritability; malaise; sharp piercing CP
Pericarditis: Diagnose & Treat - accurate answers-Dx: Chest Xray, Echo, ECG,
Cath lab, Blood Cxs.
Tx: Pain Control, Anti inflammatory rx for pain & fluid reabsorption, Restrict
Activity, Corticosteroids if no response to antiinflams
- May need surgical intervention if fluid in pericardial sac is increasing
pressure on heart.
- If severe, outer layer of Pericardium if preventing vent fxn.
