BIO 1150 - Chapter 16
Assessment
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Thomas Green
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others
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Hard
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50 questions
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1.
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30 sec
1 pt
The Coronary Arteries
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Answer explanation
The coronary arteries come off the arch of the aorta:
Left coronary artery main branch
Left anterior descending artery
Circumflex artery
Right coronary artery
Posterior descending coronary artery
2.
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30 sec
1 pt
Left Anterior Descending (LAD) Artery
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The LAD artery supplies the left ventricle and is most commonly involved in myocardial infarction.
3.
Open Ended
30 sec
1 pt
Three Layers of Heart Wall
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Endocardium
Myocardium
Epicardium (pericardium)
4.
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30 sec
1 pt
Acute Coronary Syndrome (ACS)
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Answer explanation
The most common cardiac disorders cause ischemia of the heart muscle; ACS is a term used for ischemic disorders of the heart that occur suddenly and require immediate treatment.
Important to recognize that ECG of MI and atypical angina can look the same.
ECG is not a confirmatory test for MI.
5.
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30 sec
1 pt
STEMI
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ST segment elevation myocardial infarction
6.
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30 sec
1 pt
NSTEMI
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non-ST segment elevation myocardial infarction
7.
Open Ended
30 sec
1 pt
Unstable angina (UA)
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Answer explanation
new or changing chest pain caused by ischemia
8.
Open Ended
30 sec
1 pt
Angina Pectoris
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Answer explanation
Angina pectoris is the squeezing pain in the chest that occurs when there is lack of blood flow to the myocardium (termed myocardial ischemia).
Angina can be described as stable or unstable.
9.
Open Ended
30 sec
1 pt
Stable Angina
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Answer explanation
Stable angina is chronic chest pain that the patient has experienced in the past and feels similar to past episodes.
The patient has a prescribed medication for episodes of stable angina and self-medicates for treatment.
10.
Open Ended
30 sec
1 pt
Unstable Angina (UA)
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UA is chest pain that is occurring for the first time by a patient, a sudden pain in the chest that is caused by myocardial ischemia.
UA is also the term used for chest pain that is more severe than usually experienced by the patient with chronic angina. The change in pain pattern often indicates that new regions of the heart are undergoing myocardial ischemia. UA is an emergency situation.
11.
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30 sec
1 pt
Causes of Myocardial Ischemia
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A coronary artery can be blocked by a thrombus (blood clot) that obstructs blood flow to the heart muscle, called a coronary thrombosis.
A coronary thrombosis is a consequence of endothelial injury and platelet aggregation.
If the coronary artery diameter is blocked by 50% to 70 %, an inadequate amount of blood flows past the blockage and ischemia results.
12.
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30 sec
1 pt
Causes of Myocardial Ischemia
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Another more common cause of myocardial ischemia is accumulation of hardened atherosclerotic plaque in a coronary artery.
As arteriosclerotic plaque ages, it calcifies and becomes fragile.
A piece of calcified plaque often breaks off, embolizes (travels) downstream, and lodges in a small diameter arteriole.
After lodging in the arteriole, the piece of plaque obstructs blood flow to the distal myocardial tissue.
13.
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30 sec
1 pt
Causes of Myocardial Ischemia
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A third and less common way that myocardial ischemia can occur is by coronary artery vasospasm.
Prinzmetal or variant angina is caused by a coronary artery spasm.
The vascular spasm obstructs blood flow through the coronary artery, creating ischemia in the surrounding myocardial tissue.
When the artery relaxes, circulation is returned to the myocardium.
The least common pathophysiological process that can cause angina is related to anemia. In anemia, the respiratory and circulatory systems are working properly, but there are not enough red blood cells (RBCs) or hemoglobin to carry the oxygen.
The blood itself has a deficit of oxygen.
14.
Open Ended
30 sec
1 pt
What Is Classic Cardiac Chest Pain?
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Answer explanation
Patients report retrosternal chest discomfort and use terms such as pressure, choking, squeezing, or heaviness on the chest to describe the sensation.
Classic cardiac chest pain is a crushing sensation felt on the left side of the chest radiating into the left shoulder down the left arm.
Alternatively, cardiac pain can radiate to the jaw, back, neck, right arm, or epigastric region.
15.
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30 sec
1 pt
What Is an Anginal Equivalent?
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Answer explanation
Symptoms referred to as anginal equivalents may occur instead of classic angina symptoms.
Anginal equivalents often occur in women and include symptoms such as episodic dyspnea; dizziness; lightheadedness; and pain of the jaw, epigastric region, or back in response to exertion or stress.
16.
Open Ended
30 sec
1 pt
Cardiac Chest Pain
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Answer explanation
Commonly, individuals will clench their fists over their sternum when experiencing the pain of angina.
This is known as a positive Levine's sign and is consistent with angina pectoris and MI.
The individual may become pale, dyspneic, and diaphoretic.
17.
Open Ended
30 sec
1 pt
Stress Test
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Answer explanation
A diagnostic test used specifically for angina is a thallium stress test, which is a nuclear scan used to show myocardial perfusion during exercise.
The patient exercises to maximal level on a treadmill or stationery bicycle while a radioactive substance called thallium is injected into the bloodstream.
The thallium highlights the coronary artery blood flow and deficits of blood flow to the heart while it is stressed by exercise.
18.
Open Ended
30 sec
1 pt
Diagnostic Tests for Ischemic Heart Disease
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Answer explanation
Serum cholesterol, LDL, HDL, triglycerides
ECG
Serum electrolytes
Serum glucose
High sensitivity C-reactive protein (hs-CRP)
Serum homocysteine
Cardiac enzymes; CPK
Cardiac troponins (cTn)
Chest x-ray
Calcium computed tomography (CT) scan
Cardiac angiogram and cardiac catheterization
Intravascular ultrasonography
19.
Open Ended
30 sec
1 pt
Acute MI
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Answer explanation
Acute MI is an acute coronary syndrome (ACS) that occurs when the heart tissue endures prolonged ischemia without recovery.
Myocardial cells suffer irreversible damage because of hypoxia and die in a process referred to as ischemic necrosis.
MIs are classified according to findings on an ECG as STEMI or NSTEMI.
The extent of damage caused by an MI is influenced by three factors:
- Location or level of occlusion in the coronary artery
- Length of time that the coronary artery has been occluded
- Heart's availability of collateral circulation.
20.
Open Ended
30 sec
1 pt
Signs and Symptoms of Myocardial Infarction (MI)
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Answer explanation
Diaphoresis: sweating
Dyspnea: labored breathing
Extreme anxiety, "feeling of doom"
Levine's sign (fist to chest)
Pallor
Retrosternal crushing chest pain that radiates to shoulder, arm, jaw, or back
Weak pulses
21.
Open Ended
30 sec
1 pt
ECG
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Answer explanation
The ECG can appear similar in angina pectoris and myocardial infarction.
It is important to recognize that an ECG is not a confirmatory test of MI.
22.
Open Ended
30 sec
1 pt
Cardiac Troponin (cTn)
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Answer explanation
This laboratory test is used to confirm a diagnosis of MI.
23.
Open Ended
30 sec
1 pt
Serial CPK and Troponin
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Answer explanation
When MI is suspected, clinicians usually order serial cardiac CPK and troponin I every 8 to 12 hours for 1 to 2 days to follow the progression of MI.
The rise and fall of these biomarkers provides an indication of the extent of myocardial cell death.
24.
Open Ended
30 sec
1 pt
Radionuclide Myocardial Perfusion Imaging
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Answer explanation
A radionuclide dye is injected into the bloodstream and it highlights areas of the heart that lack perfusion.
Excellent sensitivity is available to detect early acute MI.
25.
Open Ended
30 sec
1 pt
Treatment for MI and Unstable Angina
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Answer explanation
Oxygen
Morphine
Aspirin
Nitroglycerin
Thrombolytic agent * if patient is eligible
Ideally, thrombolytic agents are used within 4 hours of the beginning of the MI.
26.
Open Ended
30 sec
1 pt
Nitroglycerin
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Answer explanation
If the patient with angina takes 3 nitroglycerin tablets within a 10-minute period without relief of chest pain, assume the patient is enduring an MI.
27.
Open Ended
30 sec
1 pt
Nitroglycerin Side Effect
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Answer explanation
Nitroglycerin and other nitrate preparations can cause severe hypotension.
Nitroglycerin should not be administered with sildenafil (ViagraR) because of the risk of severe hypotension.
28.
Open Ended
30 sec
1 pt
Surgical Treatment for Ischemic Heart Disease
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Answer explanation
Angioplasty and atherectomy
Angioplasty and stent placement
Coronary artery bypass graft (CABG)
29.
Open Ended
30 sec
1 pt
Reperfusion Injury
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Answer explanation
Rapid restoration of blood flow to the myocardium also contributes to injury because of myocardial stunning.
Caused by oxidized free radicals generated by WBCs and the cellular response to restored blood flow.
30.
Open Ended
30 sec
1 pt
How Large Is the Area of Infarct?
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Answer explanation
The area of infarct is surrounded by an area of injury and an ischemic zone. Some of the cells in the injured area will recover.
The ischemic zone has salvageable tissue.
The area of infarct and ischemic zone boundaries can change postinfarction depending on the success of measures to restore blood supply such as angioplasty and thrombolytic therapy.
31.
Open Ended
30 sec
1 pt
Key Facts
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Answer explanation
Acute MI is the leading cause of death in the United States and in other industrialized nations throughout the world.
Hesitation and delayed request for emergency care are major causes of death because of MI.
Survival rates for treated patients with acute MI are 90% to 95% in the United States.
Approximately 50% of individuals who suffer an MI are younger than 65 years old.
Persons with diabetes and those older than age 65 often suffer silent, asymptomatic MI.
32.
Open Ended
30 sec
1 pt
Post-MI Arrhythmias
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Answer explanation
Within the first 24 hours of STEMI, ventricular tachycardia and ventricular fibrillation can occur without any preceding rhythm disturbance.
33.
Open Ended
30 sec
1 pt
Premature Ventricular Contractions (PVCs)
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Answer explanation
Sporadic PVCs are the most common arrhythmia occurring with MI.
During PVCs, the ventricle beats independently without waiting for the sequential conduction initiated by the SA or AV nodes. PVCs do not follow an atrial contraction and do not allow for a refractory period.
34.
Open Ended
30 sec
1 pt
ventricular tachycardia
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Answer explanation
Three PVCs in a row = ventricular tachycardia
Ventricular tachycardia does not allow for effective pumping of blood, and severely diminishes cardiac output.
35.
Open Ended
30 sec
1 pt
Ventricular Fibrillation (VF)
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Answer explanation
Rapid VT commonly initiates VF.
VF is often precipitated by a single, early PVC falling on the T wave of a previous impulse.
The lack of a refractory period is dangerous and often the rhythm degenerates into a rapid, repetitive sequence of VT that deteriorates into VF.
In VF, the ventricle is quivering and not contracting effectively to pump blood out of the chamber.
36.
Open Ended
30 sec
1 pt
Complications of MI
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Answer explanation
Papillary muscle rupture causes mitral insufficiency
Thromboembolism from stagnant blood
Ventricular aneurysm and rupture caused by massive muscle death
Pericarditis (called Dressler's syndrome)
37.
Open Ended
30 sec
1 pt
Chronic Coronary Artery Disease (Stable Angina)
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Answer explanation
Recurring episodes of chest pain caused by transient myocardial ischemia.
Patients with stable angina either cannot withstand surgical intervention or have had surgical interventions that have not been successful to relieve their angina.
Medications aim to prevent chronic angina episodes:
- Long-acting nitrates
- Calcium antagonists
- Beta blockers
- Antiplatelet medications
- Sublingual or nasal spray NTG
38.
Open Ended
30 sec
1 pt
Infective Endocarditis (IE)
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Answer explanation
The leading causative organisms are Streptococcus viridans (S. viridans), Staphylococcus aureus (S. aureus), and Staphylococcus epidermidis (S. epidermidis).
Prosthetic valve endocarditis is a common cause of IE because of the increasing numbers of valvular replacement surgeries within the growing elderly population.
Pacemaker-associated endocarditis can develop because of nosocomial infection or because of erosion of pacemaker components.
39.
Open Ended
30 sec
1 pt
What Are Septic Emboli in IE?
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Answer explanation
Microorganisms travel into the heart, adhere to damaged endothelial tissue, and attract WBCs and platelets, which release cytokines and coagulation factors.
Stimulation of the coagulation cascade results in fibrin deposition and, eventually, development of a vegetation.
Vegetations are most commonly found on valve leaflets; fragments of vegetations can embolize into the circulation.
Carried by the bloodstream, these fragments, called septic emboli, can initiate infection or ischemia in remote tissues.
40.
Open Ended
30 sec
1 pt
Symptoms in IE
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Answer explanation
Fever
Chills
Anorexia
Weight loss
Myalgias
Arthralgias
Heart murmur
Signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain may be the initial clinical manifestations of IE.
Septic emboli can lodge in a cerebral artery or arteriole and cause an ischemic stroke. Neurological symptoms from embolic stroke occur in up to 40% of patients with IE. Patients may also present with meningitis, seizures, encephalopathy, or abscesses of the brain.
41.
Open Ended
30 sec
1 pt
Classic Clinical Manifestations of IE
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Answer explanation
Pathognomonic symptoms of IE are often caused by septic emboli:
Petechiae
Splinter hemorrhages: linear streaks in the nailbeds
Janeway lesions: erythematous, nontender lesions on the palms and soles
Osler's nodes: subcutaneous nodules in the pulp of the fingertips
Roth spots: oval retinal hemorrhages with pale centers
42.
Open Ended
30 sec
1 pt
IE in IV Drug Abusers
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Answer explanation
In IV drug abusers, the veins are the portal of entry and Staphylococcus aureus (S. aureus), the flora of the skin, most commonly causes bacteremia.
Septic emboli from S. aureus travel from the peripheral vein into the inferior vena cava and into the right side of the heart.
The tricuspid valve is most often affected in IV drug users.
Septic emboli can enter the pulmonary artery -> lungs.
43.
Open Ended
30 sec
1 pt
IE in IV Drug Abusers
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Answer explanation
In IV drug abusers, the veins are the portal of entry and Staphylococcus aureus (S. aureus), the flora of the skin, most commonly causes bacteremia.
Septic emboli from S. aureus travel from the peripheral vein into the inferior vena cava and into the right side of the heart.
The tricuspid valve is most often affected in IV drug users.
Septic emboli can enter the pulmonary artery -> lungs.
44.
Open Ended
30 sec
1 pt
The Duke Criteria of IE
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Answer explanation
Infective endocarditis requires that two major criteria are met, one major and three minor criteria are met, or that five minor criteria are met.
Major Criteria
Positive blood cultures from at least two separate cultures drawn 12 hours apart
Echocardiogram showing a vegetation, abscesses, or valve perforation
New regurgitant murmur
Minor Criteria
Predisposing heart condition such as mitral valve prolapse, rheumatic or congenital heart disease, or intravenous drug abuse
Temperature greater than 100.4°F (38°C)
Presence of embolic disease or hemorrhage
Presence of immunological phenomena, such as glomerulonephritis, Osler's nodes, Roth's spots, rheumatoid factor
Positive blood culture but major criteria not met
Positive echocardiogram but major criteria not met
45.
Open Ended
30 sec
1 pt
Myocarditis
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Answer explanation
An inflammatory disease of the myocardium (muscle layer of the heart) that can range from a mild disorder to a lethal condition.
Inflammation with degeneration and necrosis of cardiac myocytes.
Conduction disruption is common.
Viruses are the most common causes of myocarditis in the United States and Europe.
Coxsackieviruses A and B account for a large proportion of the cases.
46.
Open Ended
30 sec
1 pt
Pericarditis
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Answer explanation
When the pericardium undergoes inflammation, fluid accumulates in the pericardial space.
The fluid is called a pericardial effusion and it surrounds the heart.
47.
Open Ended
30 sec
1 pt
Pericarditis and Cardiac Tamponade
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Answer explanation
If the fluid accumulates to high levels of 200 mL or greater, it can compress the heart, causing a condition called cardiac tamponade.
In cardiac tamponade, the heart chambers are restricted by the surrounding pericardial fluid so they cannot stretch and fill with blood
48.
Open Ended
30 sec
1 pt
Dressler's Syndrome
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Answer explanation
Dressler's syndrome is a specific type of pericarditis that develops post-MI.
An autoimmune reaction follows an MI after 2 to 3 weeks.
Cardiac proteins released during an MI stimulate immunoglobulins that combine with the proteins to form immune complexes.
The immune complexes are deposited in the pericardium, causing inflammation and fluid collection in the pericardial sac.
49.
Open Ended
30 sec
1 pt
Signs of Acute Pericarditis
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Answer explanation
Chest pain; sharp and worsens with deep breathing
Fever
Dyspnea
Pericardial friction rub: scratching sound can be heard through the stethoscope
ECG findings of ST elevations
Symptoms of cardiac tamponade, called the Beck triad, can be present; hypotension
Jugular vein distention
Muffled heart sounds
Pulsus paradoxus occurs in 70% to 80% of patients with cardiac tamponade.
*Pulsus paradoxus is exhibited by a decrease in systolic blood pressure of 10 mm Hg or more with inspiration.
50.
Open Ended
30 sec
1 pt
PFO
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Answer explanation
Not an ASD
Left to right shunting is unusual but may occur in the presence of a large volume load or hypertensive left atrium
Does not require surgical treatment but may be a risk for paradoxical systemic embolism
- device closure is considered if there is a history of thromboembolic shock
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