FISDAP EMT Cardiology Comprehensive Study Guide –
EMT Cardiac Emergencies Review, ECG Interpretation,
Prehospital Cardiology, ACLS Basics, FISDAP Exam Prep,
Clinical Scenarios & Critical Thinking for EMT Students
Question 1: Which chamber of the heart is primarily responsible for pumping oxygenated
blood to the systemic circulation?
A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle
CORRECT ANSWER: D. Left ventricle
Rationale: The left ventricle has the thickest myocardium and generates sufficient pressure to
propel oxygenated blood through the aorta to the entire body. The right ventricle pumps
deoxygenated blood only to the lungs via the pulmonary artery, while the atria primarily serve
as receiving chambers.
Question 2: During the cardiac cycle, what event immediately follows ventricular systole?
A. Atrial systole
B. Isovolumetric relaxation
C. Ventricular filling
D. Atrial kick
CORRECT ANSWER: B. Isovolumetric relaxation
Rationale: After ventricular systole (contraction and ejection), the ventricles enter
isovolumetric relaxation, where all valves are closed and pressure drops without a change in
volume. This phase precedes ventricular filling when the AV valves open.
Question 3: An EMT is assessing a patient with suspected acute coronary syndrome. Which
symptom is MOST indicative of cardiac origin chest pain?
A. Pain that worsens with deep inspiration
B. Pain reproducible by palpating the chest wall
C. Pain described as pressure radiating to the left arm
D. Sharp, localized pain that changes with position
CORRECT ANSWER: C. Pain described as pressure radiating to the left arm
Rationale: Cardiac chest pain is typically described as pressure, squeezing, or heaviness, often
radiating to the left arm, neck, jaw, or back. Pain worsened by inspiration, palpation, or position
changes is more suggestive of musculoskeletal or pleuritic causes.
Question 4: What is the primary purpose of administering aspirin to a patient experiencing
signs of acute myocardial infarction?
A. To relieve pain
B. To reduce inflammation
C. To inhibit platelet aggregation
D. To lower blood pressure
CORRECT ANSWER: C. To inhibit platelet aggregation
,Rationale: Aspirin irreversibly inhibits cyclooxygenase, reducing thromboxane A2 production
and platelet aggregation. This helps limit thrombus propagation in coronary arteries during
acute MI, improving outcomes when given early.
Question 5: Which rhythm is considered "shockable" by an automated external defibrillator
(AED)?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation
D. Sinus bradycardia
CORRECT ANSWER: C. Ventricular fibrillation
Rationale: AEDs are designed to detect and shock ventricular fibrillation (VF) and pulseless
ventricular tachycardia (VT), as these rhythms may respond to defibrillation. Asystole and PEA
are non-shockable rhythms requiring high-quality CPR and epinephrine.
Question 6: A patient with congestive heart failure presents with severe dyspnea, crackles
bilaterally, and pink, frothy sputum. What is the MOST appropriate immediate intervention
for the EMT?
A. Administer high-flow oxygen via non-rebreather mask
B. Place the patient in a supine position
C. Assist with prescribed nitroglycerin only if systolic BP > 100 mmHg
D. Both A and C
CORRECT ANSWER: D. Both A and C
Rationale: Patients with acute pulmonary edema benefit from high-flow oxygen to improve
oxygenation and nitroglycerin (if prescribed and BP permits) to reduce preload and afterload.
Supine positioning worsens pulmonary congestion; sitting upright is preferred.
Question 7: Which of the following is a contraindication to administering nitroglycerin to a
patient with chest pain?
A. History of hypertension
B. Systolic blood pressure of 88 mmHg
C. Age over 75 years
D. Prior myocardial infarction
CORRECT ANSWER: B. Systolic blood pressure of 88 mmHg
Rationale: Nitroglycerin causes venous and arterial dilation, which can significantly lower blood
pressure. Administering it to a patient with systolic BP < 90-100 mmHg (per local protocol) risks
profound hypotension and reduced coronary perfusion.
Question 8: What is the FIRST action an EMT should take upon arriving at the scene of an
unresponsive adult patient who is not breathing normally?
A. Apply the AED
B. Begin chest compressions
C. Check for a pulse
D. Activate emergency response and retrieve AED
CORRECT ANSWER: D. Activate emergency response and retrieve AED
,Rationale: Per current BLS guidelines, for an unresponsive adult not breathing normally, the
EMT should first ensure scene safety, then activate emergency response (call for help/AED)
before initiating CPR. Early activation ensures rapid defibrillation if needed.
Question 9: Which statement BEST describes the pathophysiology of angina pectoris?
A. Complete occlusion of a coronary artery causing myocardial necrosis
B. Transient myocardial ischemia due to oxygen supply-demand mismatch
C. Inflammation of the pericardium leading to chest pain
D. Rupture of an atherosclerotic plaque with thrombus formation
CORRECT ANSWER: B. Transient myocardial ischemia due to oxygen supply-demand
mismatch
Rationale: Angina results from temporary imbalance between myocardial oxygen supply and
demand, often due to coronary artery narrowing. Unlike MI, it does not cause irreversible cell
death and typically resolves with rest or nitroglycerin.
Question 10: During CPR on an adult patient, what is the recommended compression-to-
ventilation ratio for a single rescuer?
A. 15:2
B. 30:2
C. 5:1
D. Continuous compressions without ventilations
CORRECT ANSWER: B. 30:2
Rationale: For adult CPR by a single rescuer, the AHA recommends a 30:2 compression-to-
ventilation ratio to balance oxygenation and perfusion. This ratio applies to all adult cardiac
arrests unless an advanced airway is in place.
Question 11: Which ECG change is MOST suggestive of acute myocardial injury?
A. ST-segment depression
B. T-wave inversion
C. ST-segment elevation
D. Prolonged QT interval
CORRECT ANSWER: C. ST-segment elevation
Rationale: ST-segment elevation on a 12-lead ECG is a hallmark of acute transmural myocardial
injury (STEMI), indicating urgent need for reperfusion therapy. While other changes may occur
in ischemia, ST elevation is most specific for acute infarction.
Question 12: A patient reports taking sildenafil (Viagra) within the past 24 hours. Why is this
critical information before administering nitroglycerin?
A. Sildenafil increases the risk of bleeding with aspirin
B. Sildenafil potentiates nitroglycerin's vasodilatory effects, causing severe hypotension
C. Sildenafil masks chest pain symptoms
D. Sildenafil interferes with AED function
CORRECT ANSWER: B. Sildenafil potentiates nitroglycerin's vasodilatory effects, causing
severe hypotension
, Rationale: Both sildenafil and nitroglycerin increase nitric oxide effects, leading to profound
vasodilation. Concurrent use can cause life-threatening hypotension; thus, nitroglycerin is
contraindicated within 24-48 hours of phosphodiesterase-5 inhibitors.
Question 13: What is the MOST common cause of sudden cardiac arrest in adults?
A. Electrolyte imbalance
B. Ventricular fibrillation secondary to coronary artery disease
C. Pulmonary embolism
D. Traumatic injury
CORRECT ANSWER: B. Ventricular fibrillation secondary to coronary artery disease
Rationale: In adults, sudden cardiac arrest is most frequently caused by ventricular fibrillation
resulting from acute myocardial ischemia or infarction due to underlying coronary artery
disease. Early defibrillation is critical for survival.
Question 14: Which assessment finding is MOST concerning in a patient with suspected right
ventricular infarction?
A. Hypertension
B. Jugular venous distension with clear lung fields
C. Bilateral crackles on auscultation
D. Tachypnea with wheezing
CORRECT ANSWER: B. Jugular venous distension with clear lung fields
Rationale: Right ventricular infarction impairs right heart output, causing systemic venous
congestion (JVD) without pulmonary edema (clear lungs). This contrasts with left ventricular
failure, which typically presents with pulmonary congestion.
Question 15: When using an AED, what should the EMT do immediately after the device
analyzes the rhythm and advises "no shock indicated"?
A. Re-analyze the rhythm immediately
B. Resume CPR starting with chest compressions
C. Check for a pulse
D. Administer aspirin
CORRECT ANSWER: B. Resume CPR starting with chest compressions
Rationale: If the AED advises no shock, the rhythm is likely asystole or PEA. High-quality CPR
should be resumed immediately to maintain perfusion, as these rhythms require ongoing chest
compressions and epinephrine, not defibrillation.
Question 16: Which of the following is a modifiable risk factor for coronary artery disease?
A. Age
B. Male gender
C. Family history
D. Smoking
CORRECT ANSWER: D. Smoking
Rationale: Smoking is a major modifiable risk factor for CAD; cessation significantly reduces
cardiovascular risk. Age, gender, and family history are non-modifiable risk factors that cannot
be changed through intervention.
EMT Cardiac Emergencies Review, ECG Interpretation,
Prehospital Cardiology, ACLS Basics, FISDAP Exam Prep,
Clinical Scenarios & Critical Thinking for EMT Students
Question 1: Which chamber of the heart is primarily responsible for pumping oxygenated
blood to the systemic circulation?
A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle
CORRECT ANSWER: D. Left ventricle
Rationale: The left ventricle has the thickest myocardium and generates sufficient pressure to
propel oxygenated blood through the aorta to the entire body. The right ventricle pumps
deoxygenated blood only to the lungs via the pulmonary artery, while the atria primarily serve
as receiving chambers.
Question 2: During the cardiac cycle, what event immediately follows ventricular systole?
A. Atrial systole
B. Isovolumetric relaxation
C. Ventricular filling
D. Atrial kick
CORRECT ANSWER: B. Isovolumetric relaxation
Rationale: After ventricular systole (contraction and ejection), the ventricles enter
isovolumetric relaxation, where all valves are closed and pressure drops without a change in
volume. This phase precedes ventricular filling when the AV valves open.
Question 3: An EMT is assessing a patient with suspected acute coronary syndrome. Which
symptom is MOST indicative of cardiac origin chest pain?
A. Pain that worsens with deep inspiration
B. Pain reproducible by palpating the chest wall
C. Pain described as pressure radiating to the left arm
D. Sharp, localized pain that changes with position
CORRECT ANSWER: C. Pain described as pressure radiating to the left arm
Rationale: Cardiac chest pain is typically described as pressure, squeezing, or heaviness, often
radiating to the left arm, neck, jaw, or back. Pain worsened by inspiration, palpation, or position
changes is more suggestive of musculoskeletal or pleuritic causes.
Question 4: What is the primary purpose of administering aspirin to a patient experiencing
signs of acute myocardial infarction?
A. To relieve pain
B. To reduce inflammation
C. To inhibit platelet aggregation
D. To lower blood pressure
CORRECT ANSWER: C. To inhibit platelet aggregation
,Rationale: Aspirin irreversibly inhibits cyclooxygenase, reducing thromboxane A2 production
and platelet aggregation. This helps limit thrombus propagation in coronary arteries during
acute MI, improving outcomes when given early.
Question 5: Which rhythm is considered "shockable" by an automated external defibrillator
(AED)?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation
D. Sinus bradycardia
CORRECT ANSWER: C. Ventricular fibrillation
Rationale: AEDs are designed to detect and shock ventricular fibrillation (VF) and pulseless
ventricular tachycardia (VT), as these rhythms may respond to defibrillation. Asystole and PEA
are non-shockable rhythms requiring high-quality CPR and epinephrine.
Question 6: A patient with congestive heart failure presents with severe dyspnea, crackles
bilaterally, and pink, frothy sputum. What is the MOST appropriate immediate intervention
for the EMT?
A. Administer high-flow oxygen via non-rebreather mask
B. Place the patient in a supine position
C. Assist with prescribed nitroglycerin only if systolic BP > 100 mmHg
D. Both A and C
CORRECT ANSWER: D. Both A and C
Rationale: Patients with acute pulmonary edema benefit from high-flow oxygen to improve
oxygenation and nitroglycerin (if prescribed and BP permits) to reduce preload and afterload.
Supine positioning worsens pulmonary congestion; sitting upright is preferred.
Question 7: Which of the following is a contraindication to administering nitroglycerin to a
patient with chest pain?
A. History of hypertension
B. Systolic blood pressure of 88 mmHg
C. Age over 75 years
D. Prior myocardial infarction
CORRECT ANSWER: B. Systolic blood pressure of 88 mmHg
Rationale: Nitroglycerin causes venous and arterial dilation, which can significantly lower blood
pressure. Administering it to a patient with systolic BP < 90-100 mmHg (per local protocol) risks
profound hypotension and reduced coronary perfusion.
Question 8: What is the FIRST action an EMT should take upon arriving at the scene of an
unresponsive adult patient who is not breathing normally?
A. Apply the AED
B. Begin chest compressions
C. Check for a pulse
D. Activate emergency response and retrieve AED
CORRECT ANSWER: D. Activate emergency response and retrieve AED
,Rationale: Per current BLS guidelines, for an unresponsive adult not breathing normally, the
EMT should first ensure scene safety, then activate emergency response (call for help/AED)
before initiating CPR. Early activation ensures rapid defibrillation if needed.
Question 9: Which statement BEST describes the pathophysiology of angina pectoris?
A. Complete occlusion of a coronary artery causing myocardial necrosis
B. Transient myocardial ischemia due to oxygen supply-demand mismatch
C. Inflammation of the pericardium leading to chest pain
D. Rupture of an atherosclerotic plaque with thrombus formation
CORRECT ANSWER: B. Transient myocardial ischemia due to oxygen supply-demand
mismatch
Rationale: Angina results from temporary imbalance between myocardial oxygen supply and
demand, often due to coronary artery narrowing. Unlike MI, it does not cause irreversible cell
death and typically resolves with rest or nitroglycerin.
Question 10: During CPR on an adult patient, what is the recommended compression-to-
ventilation ratio for a single rescuer?
A. 15:2
B. 30:2
C. 5:1
D. Continuous compressions without ventilations
CORRECT ANSWER: B. 30:2
Rationale: For adult CPR by a single rescuer, the AHA recommends a 30:2 compression-to-
ventilation ratio to balance oxygenation and perfusion. This ratio applies to all adult cardiac
arrests unless an advanced airway is in place.
Question 11: Which ECG change is MOST suggestive of acute myocardial injury?
A. ST-segment depression
B. T-wave inversion
C. ST-segment elevation
D. Prolonged QT interval
CORRECT ANSWER: C. ST-segment elevation
Rationale: ST-segment elevation on a 12-lead ECG is a hallmark of acute transmural myocardial
injury (STEMI), indicating urgent need for reperfusion therapy. While other changes may occur
in ischemia, ST elevation is most specific for acute infarction.
Question 12: A patient reports taking sildenafil (Viagra) within the past 24 hours. Why is this
critical information before administering nitroglycerin?
A. Sildenafil increases the risk of bleeding with aspirin
B. Sildenafil potentiates nitroglycerin's vasodilatory effects, causing severe hypotension
C. Sildenafil masks chest pain symptoms
D. Sildenafil interferes with AED function
CORRECT ANSWER: B. Sildenafil potentiates nitroglycerin's vasodilatory effects, causing
severe hypotension
, Rationale: Both sildenafil and nitroglycerin increase nitric oxide effects, leading to profound
vasodilation. Concurrent use can cause life-threatening hypotension; thus, nitroglycerin is
contraindicated within 24-48 hours of phosphodiesterase-5 inhibitors.
Question 13: What is the MOST common cause of sudden cardiac arrest in adults?
A. Electrolyte imbalance
B. Ventricular fibrillation secondary to coronary artery disease
C. Pulmonary embolism
D. Traumatic injury
CORRECT ANSWER: B. Ventricular fibrillation secondary to coronary artery disease
Rationale: In adults, sudden cardiac arrest is most frequently caused by ventricular fibrillation
resulting from acute myocardial ischemia or infarction due to underlying coronary artery
disease. Early defibrillation is critical for survival.
Question 14: Which assessment finding is MOST concerning in a patient with suspected right
ventricular infarction?
A. Hypertension
B. Jugular venous distension with clear lung fields
C. Bilateral crackles on auscultation
D. Tachypnea with wheezing
CORRECT ANSWER: B. Jugular venous distension with clear lung fields
Rationale: Right ventricular infarction impairs right heart output, causing systemic venous
congestion (JVD) without pulmonary edema (clear lungs). This contrasts with left ventricular
failure, which typically presents with pulmonary congestion.
Question 15: When using an AED, what should the EMT do immediately after the device
analyzes the rhythm and advises "no shock indicated"?
A. Re-analyze the rhythm immediately
B. Resume CPR starting with chest compressions
C. Check for a pulse
D. Administer aspirin
CORRECT ANSWER: B. Resume CPR starting with chest compressions
Rationale: If the AED advises no shock, the rhythm is likely asystole or PEA. High-quality CPR
should be resumed immediately to maintain perfusion, as these rhythms require ongoing chest
compressions and epinephrine, not defibrillation.
Question 16: Which of the following is a modifiable risk factor for coronary artery disease?
A. Age
B. Male gender
C. Family history
D. Smoking
CORRECT ANSWER: D. Smoking
Rationale: Smoking is a major modifiable risk factor for CAD; cessation significantly reduces
cardiovascular risk. Age, gender, and family history are non-modifiable risk factors that cannot
be changed through intervention.
