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Questions and Answers
What is the primary function of the heart?
Which layer of the heart is responsible for its contracting ability?
What is the term for low oxygen in the blood?
What is considered the universal sign of chest pain in patients experiencing angina pectoris?
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Which diagnostic test graphically represents cardiac electrical activity?
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Which substance is NOT a component needed to form ATP in the heart?
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What condition results from an accumulation of fluid in the pericardial space?
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How long does it typically take for troponin levels to elevate after myocardial tissue damage?
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What complication is most commonly associated with an acute myocardial infarction?
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What is the role of potassium in heart physiology?
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Which of the following describes the process of respiration?
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Which segment on an ECG is indicative of an injury to the heart muscle?
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Which substance is considered the gold standard biomarker for diagnosing myocardial infarction?
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What effect does hypoxemia have on metabolic processes?
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What is the recommended position for a patient experiencing an acute myocardial infarction to promote lung expansion?
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What can untreated premature ventricular complex (PVC) potentially lead to?
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What is the primary action of nitrates such as Nitroglycerin in relation to myocardial demand?
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Why is it crucial to avoid straining during recovery from cardiac issues?
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What is the recommended maximum duration for a nitrate patch to remain on the skin?
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Which of the following interventions should be avoided when applying a transdermal nitrate patch?
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What is a sign that medication administration should be halted due to respiratory issues?
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Which dietary recommendation is advised for patients recovering from a cardiac event?
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What should healthcare providers do to ensure safety before administering nitrate medications?
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What condition can result from administering nitrates if a patient has a very low respiratory rate?
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Study Notes
Signs and Symptoms of Acute Coronary Syndrome (ACS)
- Pain Characteristics: Substernal pain with radiation to jaw, neck, shoulder, arm, and back.
- Abnormal Heartbeat: Pounding sensation (palpitations) and chest tightness are common.
- Tachycardia: Increased heart rate perceived as "indigestion".
- Levine's Sign: Patient may clutch chest, indicating chest pain.
- Angina Pectoris: Pain lasts less than 15 minutes, relieved by rest and nitrates.
- Myocardial Infarction (MI): Pain persists longer than 15 minutes, unrelieved by rest or nitrates; treated with morphine.
Diagnostic Tests
-
Electrocardiogram (ECG): Displays cardiac electrical activity; used to diagnose ischemia, injury, and infarction.
- QRS Complex: Indicative of ventricular contraction.
- T-wave inversion suggests ischemia.
- ST segment elevation indicates injury.
- Large or pathologic Q waves show infarction.
-
Serum Cardiac Biomarkers: Indicators of myocardial tissue death; namely:
- Myoglobin: Elevates after 1 hour.
- Troponin: Elevates within 2-4 hours, considered gold standard.
- CK-MB: Elevates 4-6 hours post-event.
- AST: Elevates after 8 hours.
- LDH: Elevates after 24 hours.
Heart Status Monitoring
- Monitored through vital signs, telemetry for continuous ECG, and serum biomarkers.
- Oxygen Therapy: Priority in enhancing myocardial tissue oxygenation, position patient in high Fowler's for lung expansion.
- Acute MI Complications: Monitor for cardiac arrhythmias such as PVC, which can lead to VTach and V-fibrillation.
Anatomy and Physiology of the Heart
- Location: Heart located in the mediastinum, deviating to the left, average weight is 300 grams.
- Function: Pumps blood throughout the body; emotion regulation comes from the hypothalamus.
- Contraction: Heart muscles contract using energy from ATP produced via aerobic metabolism.
- Key Components for ATP: Oxygen, glucose, phosphorus, and potassium is the essential electrolyte.
Heart Wall Structure
-
Layers:
- Endocardium: Inner layer, inflammation causes endocarditis.
- Myocardium: Muscular middle layer, inflammation leads to myocarditis.
- Epicardium: Outermost layer.
Pericardium
- Thin fibrous sac encasing the heart, potentially leading to pericarditis if swollen.
- Pericardial Effusion: Fluid accumulation can compress the heart, causing cardiac tamponade, which compromises circulation leading to cardiogenic shock.
Pulse and Survival
- Pulse indicates left ventricular contraction; delay in treatment leads to cardiac arrest risk.
- Recommendations: Complete bed rest in the first 24 hours, passive range of motion exercises, low-sodium/quinoa diet, recommend avoiding smoking.
Medication Treatment for ACS
-
Nitrates: Used as vasodilators in MI management; key types include:
- Nitroglycerin, Isosorbide Dinitrate, Isosorbide Mononitrate.
- Administration: Transdermal application recommended; avoid shaving at application site to prevent rapid absorption.
- Mechanism of Action: Decreases myocardial demand, cardiac workload, vascular resistance, and pain perception; IV form available for rapid effect.
- Adverse Effects: CNS and respiratory depression possible; monitor respiratory rate before administration.
Emergency Considerations
- Respiratory Monitoring: Check rates carefully, particularly with low rates; report significantly low rates (e.g., 10 bpm) immediately.
- Antidotes: Naloxone (Narcan) for overdose; Methadone for withdrawal.
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Description
This quiz focuses on the signs and symptoms associated with Acute Coronary Syndrome (ACS), including pain characteristics, abnormal heartbeats, and specific gestures indicative of distress. Important clinical concepts such as angina pectoris and Levine's sign are covered, aiding in recognition and understanding of ACS manifestations.
