Podcast
Questions and Answers
The reciprocal changes of a posterior MI are evident in which leads?
The reciprocal changes of a posterior MI are evident in which leads?
What would be a desirable therapeutic outcome after administering Verapamil 5 mg to a patient with paroxysmal atrial tachycardia?
What would be a desirable therapeutic outcome after administering Verapamil 5 mg to a patient with paroxysmal atrial tachycardia?
Which of the following is the most common cause of death associated with an acute MI?
Which of the following is the most common cause of death associated with an acute MI?
If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:
If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:
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Which drug has Class II and Class III properties?
Which drug has Class II and Class III properties?
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The skin changes associated with chronic peripheral arterial disease are:
The skin changes associated with chronic peripheral arterial disease are:
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If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?
If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?
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Which of the following defines syncope?
Which of the following defines syncope?
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Clinical indications of a right tension pneumothorax include which of the following?
Clinical indications of a right tension pneumothorax include which of the following?
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Which treatment is appropriate for a 70-year-old woman with ventricular tachycardia and HR 150?
Which treatment is appropriate for a 70-year-old woman with ventricular tachycardia and HR 150?
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Which describes the function of a DVI pacemaker?
Which describes the function of a DVI pacemaker?
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What should a patient be prepared for if chest pain returns after PCI?
What should a patient be prepared for if chest pain returns after PCI?
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Which would not be associated with a false-positive result for an acute MI using total creatine kinase (CK)?
Which would not be associated with a false-positive result for an acute MI using total creatine kinase (CK)?
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What does an S3 heart sound indicate?
What does an S3 heart sound indicate?
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Which is the best hemodynamic parameter for assessing left ventricular function?
Which is the best hemodynamic parameter for assessing left ventricular function?
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Which of the following are therapeutic goals for drug therapy for dilated cardiomyopathy?
Which of the following are therapeutic goals for drug therapy for dilated cardiomyopathy?
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Which of the following would not be important for a patient receiving nitroprusside?
Which of the following would not be important for a patient receiving nitroprusside?
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What is the most likely cause of deterioration in a patient post-MI with a holosystolic murmur?
What is the most likely cause of deterioration in a patient post-MI with a holosystolic murmur?
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Which factor is helpful in deciding whether a 2:1 AV block is likely type II second-degree?
Which factor is helpful in deciding whether a 2:1 AV block is likely type II second-degree?
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Occlusion of the RCA would cause ST elevation in which leads?
Occlusion of the RCA would cause ST elevation in which leads?
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Which correlates with brain natriuretic peptide (BNP) levels?
Which correlates with brain natriuretic peptide (BNP) levels?
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What is the purpose of administering low-molecular-weight dextran after an aortofemoral bypass graft?
What is the purpose of administering low-molecular-weight dextran after an aortofemoral bypass graft?
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Which finding would occur in dilated cardiomyopathy?
Which finding would occur in dilated cardiomyopathy?
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Which medication is contraindicated in a patient with Wolff-Parkinson-White (WPW) syndrome?
Which medication is contraindicated in a patient with Wolff-Parkinson-White (WPW) syndrome?
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Which study is most diagnostic in identifying a MI in a patient with unstable angina?
Which study is most diagnostic in identifying a MI in a patient with unstable angina?
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What is the most likely optimal PAOP in a patient experiencing cardiogenic shock?
What is the most likely optimal PAOP in a patient experiencing cardiogenic shock?
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Which medication prescribed for a patient with stable angina does not decrease myocardial oxygen consumption?
Which medication prescribed for a patient with stable angina does not decrease myocardial oxygen consumption?
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Which is the most common complication of infective endocarditis?
Which is the most common complication of infective endocarditis?
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What correlates most directly with the need for electrical cardioversion for a tachydysrhythmia?
What correlates most directly with the need for electrical cardioversion for a tachydysrhythmia?
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What is the most frequently identified primary mechanism of cardiac arrest?
What is the most frequently identified primary mechanism of cardiac arrest?
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Which are the two most common dysrhythmias associated with Wolff-Parkinson-White syndrome?
Which are the two most common dysrhythmias associated with Wolff-Parkinson-White syndrome?
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What should be suspected if a patient complains of severe thigh pain and other symptoms post-surgery?
What should be suspected if a patient complains of severe thigh pain and other symptoms post-surgery?
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Which medication is associated with thiocyanate toxicity?
Which medication is associated with thiocyanate toxicity?
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What effect does sympathetic nervous system stimulation have on the heart during cardiac arrest?
What effect does sympathetic nervous system stimulation have on the heart during cardiac arrest?
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What would be an appropriate treatment for a patient diagnosed with decreased cardiac contractility after a heart transplant?
What would be an appropriate treatment for a patient diagnosed with decreased cardiac contractility after a heart transplant?
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Which vessel is used as a graft in MIDCABG procedures?
Which vessel is used as a graft in MIDCABG procedures?
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Which of the following may be useful in systolic dysfunction but detrimental in diastolic dysfunction?
Which of the following may be useful in systolic dysfunction but detrimental in diastolic dysfunction?
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What is the most likely pathophysiologic problem in an elderly patient admitted with acute respiratory distress?
What is the most likely pathophysiologic problem in an elderly patient admitted with acute respiratory distress?
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What are two significant adverse effects of ACE inhibitors?
What are two significant adverse effects of ACE inhibitors?
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What describes a VDD pacemaker?
What describes a VDD pacemaker?
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What does a wide-notched P wave in lead II most likely indicate?
What does a wide-notched P wave in lead II most likely indicate?
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When pulmonary artery diastolic pressure is more than 5 mm Hg higher than pulmonary artery occlusive pressure, it signals which condition?
When pulmonary artery diastolic pressure is more than 5 mm Hg higher than pulmonary artery occlusive pressure, it signals which condition?
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A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?
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Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected RCA occlusion?
Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected RCA occlusion?
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Which of the following is not a manifestation of hypertrophic cardiomyopathy?
Which of the following is not a manifestation of hypertrophic cardiomyopathy?
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In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly positive in lead I and negative in lead aVF?
In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly positive in lead I and negative in lead aVF?
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A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole in two leads. Which of the following drugs would be used initially?
A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole in two leads. Which of the following drugs would be used initially?
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What is associated with mitral stenosis?
What is associated with mitral stenosis?
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Four days after a mitral valve replacement, the patient develops atrial fibrillation. The nurse initially would:
Four days after a mitral valve replacement, the patient develops atrial fibrillation. The nurse initially would:
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A patient has just returned from the cath lab. She had an angioplasty for occlusion of her RCA. She still has femoral artery and vein sheaths in place. The patient complains of chest pain that she rates 9/10 about an hour after she returns from the cath lab. Which of the following is indicated?
A patient has just returned from the cath lab. She had an angioplasty for occlusion of her RCA. She still has femoral artery and vein sheaths in place. The patient complains of chest pain that she rates 9/10 about an hour after she returns from the cath lab. Which of the following is indicated?
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A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15, PAOP 13. What other data would indicate the development of cardiac tamponade?
A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15, PAOP 13. What other data would indicate the development of cardiac tamponade?
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A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient?
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient?
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A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol?
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol?
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A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80 pack-years of smoking, COPD, and HLD. An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an indication of successful reperfusion?
A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80 pack-years of smoking, COPD, and HLD. An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an indication of successful reperfusion?
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Substernal chest pain, low-grade fever, and pericardial friction rub are clinical indications of which of the following?
Substernal chest pain, low-grade fever, and pericardial friction rub are clinical indications of which of the following?
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A patient sustains a myocardial contusion as a result of a MVC. Which of the following signs and symptoms would be most likely?
A patient sustains a myocardial contusion as a result of a MVC. Which of the following signs and symptoms would be most likely?
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A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV block with a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV block with a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
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Which one of the following structures is at greatest risk for trauma in myocardial contusion?
Which one of the following structures is at greatest risk for trauma in myocardial contusion?
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Leads V8 and V9 are used to evaluate which of the following?
Leads V8 and V9 are used to evaluate which of the following?
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Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)?
Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)?
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A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done?
A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done?
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A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hours after admission, the patient becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time?
A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hours after admission, the patient becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time?
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What type of AV block is characterized by a progressive prolongation of the PR interval followed by a nonconducted P wave?
What type of AV block is characterized by a progressive prolongation of the PR interval followed by a nonconducted P wave?
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A premature P wave buried in the T wave before a run of wide QRS complex tachycardia indicates that the wide QRS complex tachycardia is most likely which of the following?
A premature P wave buried in the T wave before a run of wide QRS complex tachycardia indicates that the wide QRS complex tachycardia is most likely which of the following?
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Which of the following drugs are used for first-line therapy for chronic management of hypertension?
Which of the following drugs are used for first-line therapy for chronic management of hypertension?
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A 61-year-old man is admitted to the critical care unit from the cath lab. He has just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB is 30 degrees. Six hours later the patient is restless and complaining of back pain. The femoral sheath is intact in the right femoral area, and there is no evidence of bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart sounds are normal. Vital signs are BP 80/50, HR 120, and RR 24. Which of the following is the priority issue for patient education for this patient?
A 61-year-old man is admitted to the critical care unit from the cath lab. He has just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB is 30 degrees. Six hours later the patient is restless and complaining of back pain. The femoral sheath is intact in the right femoral area, and there is no evidence of bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart sounds are normal. Vital signs are BP 80/50, HR 120, and RR 24. Which of the following is the priority issue for patient education for this patient?
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Unstable angina that presents as pain at rest is likely to be due to progression of CAD or which of the following?
Unstable angina that presents as pain at rest is likely to be due to progression of CAD or which of the following?
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Which of the following is the major disadvantage of the use of serum myoglobin for the diagnosis of an acute MI?
Which of the following is the major disadvantage of the use of serum myoglobin for the diagnosis of an acute MI?
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Which of the following is the most likely mechanism for atrial tachycardias?
Which of the following is the most likely mechanism for atrial tachycardias?
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Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator?
Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator?
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A patient returns to the critical care unit after insertion of a transvenous pacemaker. There are pacing spikes not followed by a QRS. Which of the following is a method to facilitate capture during pacing?
A patient returns to the critical care unit after insertion of a transvenous pacemaker. There are pacing spikes not followed by a QRS. Which of the following is a method to facilitate capture during pacing?
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Reduction in peripheral circulation and shifting of the oxyhemoglobin dissociation curve can affect the accuracy of which of the following?
Reduction in peripheral circulation and shifting of the oxyhemoglobin dissociation curve can affect the accuracy of which of the following?
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Which of the following would not be recommended for diastolic dysfunction?
Which of the following would not be recommended for diastolic dysfunction?
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Why does nitroprusside (Nipride) cause tachycardia?
Why does nitroprusside (Nipride) cause tachycardia?
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Aortic stenosis would elevate which of the following?
Aortic stenosis would elevate which of the following?
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Which of the following does not predispose the patient to digitalis toxicity?
Which of the following does not predispose the patient to digitalis toxicity?
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Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough?
Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough?
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Ashman's phenomenon is most likely to be evident in which of the following electrocardiogram changes?
Ashman's phenomenon is most likely to be evident in which of the following electrocardiogram changes?
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Which of the following is a clinical indication of diastolic dysfunction?
Which of the following is a clinical indication of diastolic dysfunction?
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Which of the following type of drug would be prescribed after a MI to aid in prevention of remodeling?
Which of the following type of drug would be prescribed after a MI to aid in prevention of remodeling?
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Which of the following are clinical indications of bacterial endocarditis?
Which of the following are clinical indications of bacterial endocarditis?
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While monitoring the patient's PAP, a damped waveform is noted. Which of the following would not be an appropriate action?
While monitoring the patient's PAP, a damped waveform is noted. Which of the following would not be an appropriate action?
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Which of the following is not characteristic of the clinical presentation of dissecting thoracic aortic aneurysm?
Which of the following is not characteristic of the clinical presentation of dissecting thoracic aortic aneurysm?
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Which of the following is an important group of drugs used to block a maladaptive compensatory mechanism in HF?
Which of the following is an important group of drugs used to block a maladaptive compensatory mechanism in HF?
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A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this patient not be expected to receive?
A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this patient not be expected to receive?
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Study Notes
Coronary Artery and EKG Insights
- ST elevation in leads V3 and V4 indicates possible LAD (Left Anterior Descending) artery occlusion, impacting the Bundle of His.
- For RCA occlusion, lead III is preferred for ST segment monitoring.
Hypertrophic Cardiomyopathy Manifestations
- Classic signs include chest pain, syncope, and a murmur decreasing with squatting. Sudden cardiac death can occur during exertion.
Conduction System and Mean QRS Axis
- A QRS complex positive in lead I and negative in lead aVF suggests left axis deviation.
Cardiac Arrest and Asystole
- In case of asystole post-CPR, administer epinephrine immediately after establishing IV access.
Mitral Stenosis Indicators
- Pinkish discoloration (malar blush) in cheeks is a sign of mitral stenosis, typically accompanied by a diastolic murmur.
Post-Mitral Valve Replacement Complications
- Atrial fibrillation may lead to reduced cardiac output. Assess for hypoperfusion symptoms.
Chest Pain Post-Angioplasty
- Severe chest pain following RCA angioplasty raises concerns for possible acute closure necessitating immediate physician notification.
Cardiac Tamponade Signs
- Muffled heart sounds are a key indicator of cardiac tamponade, along with classic Beck's triad signs.
MI Complications
- New holosystolic murmur in inferior MI patients may indicate acute mitral regurgitation due to papillary muscle dysfunction.
Pharmacological Interventions
- Carvedilol is classified as an alpha- and noncardioselective beta-blocker, beneficial for heart failure with diastolic dysfunction.
Reperfusion Indicators after MI
- Successful reperfusion may be indicated by pain cessation and ST segment normalization, but not necessarily by creatine kinase enzyme elevation.
Pericarditis Clinical Features
- Symptoms of pericarditis include substernal chest pain, low-grade fever, and a pericardial friction rub.
Myocardial Contusion Symptoms
- Jugular venous distention is a likely sign of myocardial contusion from trauma.
Transvenous Pacemaker Functionality
- Dizziness with a non-capturing ventricular pacemaker indicates a failure to pace.
Risks in Myocardial Contusion
- The right ventricle is at greatest risk for trauma in myocardial contusion scenarios.
Lead Utilization in Cardiac Assessment
- Leads V8 and V9 are critical for evaluating posterior myocardial infarction.
MIDCABG Advantages
- Major benefit of minimally invasive coronary artery bypass grafting includes avoidance of cardiopulmonary bypass.
Management of Knife Injury
- A knife embedded in the chest should remain in place for stability; do not remove.
Critical Care Observations
- Observe vital signs closely, especially in patients with signs of hypoperfusion after cardiac interventions.
AV Block Characteristics
- Second-degree AV block, type I shows progressive PR interval prolongation followed by a missed beat.
Tachycardia Mechanisms
- Atrial tachycardias are mostly due to re-entry mechanisms.
Contraindications for Fibrinolytics
- Uncontrolled hypertension is a significant contraindication for administering fibrinolytic drugs.
Capture Facilitation in Pacing
- To enhance pacing capture, increase the milliamperage when pacing spikes are present without subsequent QRS.
Pulse Oximetry Accuracy
- Reduced peripheral circulation and oxyhemoglobin dissociation curve shifts can affect the accuracy of pulse oximetry.
Drug Interactions in Heart Failure
- Avoid inotropes in diastolic dysfunction management; ACE inhibitors and beta-blockers are more suitable.
Drug Properties for Atrial Fibrillation
- Sotalol showcases both Class II and Class III antiarrhythmic properties.
Peripheral Arterial Disease Symptoms
- Skin in chronic peripheral arterial disease appears pale and shiny, often indicating reduced circulation.
Pressure Measurement Implications
- The position of the zero reference port in a pressure monitoring system affects the accuracy of pressure readings.### Cardiology Assessments and Interventions
- Pressures recorded in certain contexts can be falsely high or low by approximately 4 mm Hg.
- Syncope is defined as a transient loss of consciousness.
- Right tension pneumothorax clinical indicators include tracheal shift toward the left with diminished breath sounds on the right.
- In cases of ventricular tachycardia, synchronized cardioversion starting at 100 J is an appropriate treatment option.
- Failure of a transvenous temporary ventricular pacemaker can necessitate a permanent DVI pacemaker, which paces the ventricle and senses both atrium and ventricle but is inhibited by the QRS complex.
Chest Pain Management
- Post-percutaneous coronary intervention (PCI) chest pain that does not respond to nitroglycerin may require a return to cardiac catheterization.
- A false-positive result for acute myocardial infarction using total creatine kinase (CK) can arise from factors excluding ulcerative colitis.
- S3 heart sounds indicate rapid ventricular filling into an already distended ventricle.
Hemodynamics and Heart Function
- Pulmonary artery occlusive pressure (PAOP) is a crucial hemodynamic parameter for assessing left ventricular function.
- Therapeutic goals for dilated cardiomyopathy treatment focus on increasing contractility while reducing afterload and preload.
Patient Monitoring and Safety
- Precautions for patients on nitroprusside include monitoring for hypoxia, frequent blood pressure checks, and vigilance for signs of thiocyanate poisoning.
- Symptoms like a loud holosystolic murmur and pulmonary crackles in a post-MI patient may indicate a ruptured papillary muscle.
- Recognition of 2:1 AV block requires understanding QRS width and myocardial infarction history to deduce type II second-degree AV block.
Electrocardiogram (ECG) Insights
- Occlusion of the right coronary artery (RCA) can lead to ST elevation in leads II, III, and aVF.
- Brain natriuretic peptide (BNP) correlates with pulmonary artery occlusive pressure and indicates heart failure severity.
Pharmacological Implications
- Low-molecular-weight dextran reduces platelet aggregation post-surgery to minimize thrombus formation.
- Not every medication prescribed for stable angina decreases myocardial oxygen consumption; aspirin does not.
- Nitroprusside is associated with the risk of thiocyanate toxicity.
Complications and Risk Management
- Emboli are the most common complication related to infective endocarditis.
- Ventricular fibrillation is the most frequently identified primary mechanism of cardiac arrest.
Specific Conditions and Treatments
- In acute pulmonary edema, assessing hemodynamics may reveal blood pressure variations and increased respiratory rates.
- Vasodilators may aid systolic dysfunction but could worsen diastolic function, necessitating careful patient evaluation.
Postoperative Care and Interventions
- Following cardiac surgery, cold, clammy skin, and elevated jugular venous distention could indicate decreased cardiac contractility, treated with beta-adrenergic stimulants.
- Internal thoracic artery is commonly used as a graft in minimally invasive direct coronary artery bypass surgery.
Diagnostic Indicators
- Anterior wall myocardial infarction may correlate with QRS widening.
- Increased platelet aggregation can be detrimental; thus, monitoring specific vasodilators' effects post-operatively is necessary.
Specialized Knowledge
- Mitral valve disease is often indicated by wide-notched P waves observed in ECG leads.
- Significant pulmonary hypertension is suggested by a pulmonary arterial diastolic pressure exceeding PAOP by over 5 mm Hg.
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