CMC Cardiac Medicine Certification
Exam-Graded A
Acute Coronary Syndrome (ACS): any group of clinical symptoms resulting from acute
myocardial ischemia. - Correct Answers-begins with the rupture of atherosclerotic
plaque, creating an injured area on the endothelium.
platelet activation of the coagulation cascade and the formation of a thrombus over the
injured area ensues - Correct Answers-restricted blood flow, cardiac ischemia and chest
pain, the most common symptom of ACS.
ACS is divided into three categories: - Correct Answers-unstable angina (USA)
Non ST segment elevation MI (NSTEMI)
ST segment elevation MI (STEMI).
unstable angina (USA) - Correct Answers-no rise in cardiac biomarkers. If there is a
decrease in left ventricular function secondary to cardiac ischemia, it returns to normal
after the ischemia has resolved.
Non-STEMI
No evidence of ST elevation. - Correct Answers-Cardiac biomarker levels rise but the
levels will not be high enough to render a positive test result. May be left ventricular
dysfunction after NSTEMI resolves
STEMI - Correct Answers-ST elevations will be present in different leads depending on
injury location; a Q wave may be present. CK-MB and troponin are positive; high risk for
left ventricular dysfunction.
Risk factors for ACS include: - Correct Answers-CAD, atherosclerotic plaque on the
walls of the arteries; age >55, Male; smoking, obesity, HTN, ETOH,
hypercholesterolemia, sedentary lifestyle; uncontrolled DM
Myocardial ischemia is characterized by - Correct Answers-T-wave inversion on an
ECG.
Infarction is characterized by a Q wave duration of 0.04 seconds or longer. - Correct
Answers-The Q wave will also be approximately one-fourth to one-third the height of the
R wave.
, 40% to 50% of MIs involve the INFERIOR WALL - Correct Answers-In 80% of patients,
the inferior wall is supplied by the RCA via the posterior descending artery (Right-
dominance).
Good prognosis (<10% mortality)
40% to 50% of MIs involve the INFERIOR WALL - Correct Answers-In the other 20%,
the posterior descending artery is a branch of the circumflex artery (Left-dominance).
40% of INFERIOR WALL MIs involve the RIGHT VENTRICLE - Correct Answers-worse
outcome
hypotension, bradycardia, heart block, and cardiogenic shock
Bradycardias, heart blocks and arrhythmias associated with inferior wall MIs - Correct
Answers-The right coronary artery perfuses the sinoatrial node and AV node.
Most common ECG finding with inferior wall MI - Correct Answers-ST elevation in II, III
and aVF Reciprocal ST depression in lead aVL.
If right ventricular involvement suspected - Correct Answers-Performed a "right-sided
EKG" by reversing the precordial leads to the right side of the chest in a mirror image of
the traditional precordial leads.
Suspect right ventricular infarction in ALL inferior wall MIs. Do a right-sided EKG... -
Correct Answers-ST elevations is V3R-V6R confirms right ventricular MI
In patients presenting with inferior wall MI, right ventricular infarction is suggested by the
presence of: - Correct Answers-ST elevation in V1 (the only lead that looks directly at
the right ventricle).
Plus
ST depression in V2 (= highly specific for RV MI).
The ECG findings in occlusion of circumflex artery or branch from the LAD artery -
Correct Answers-ST elevations in leads I and aVL,
Reciprocal changes in V1 and V3.
POSTERIOR wall MI - Correct Answers-Occlusion in posterior descending artery — a
branch of the RCA.
May see inferior MI at same time due to shared blood supply.
The ECG findings in POSTERIOR wall MI - Correct Answers-ST Depression in V1-V4
ST elevation in V7-V9 (posterior EKG)
The ECG findings in POSTERIOR wall MI - Correct Answers-If R wave > S wave in V1
and V2, possible occlusion in RCA or circumflex artery.
Exam-Graded A
Acute Coronary Syndrome (ACS): any group of clinical symptoms resulting from acute
myocardial ischemia. - Correct Answers-begins with the rupture of atherosclerotic
plaque, creating an injured area on the endothelium.
platelet activation of the coagulation cascade and the formation of a thrombus over the
injured area ensues - Correct Answers-restricted blood flow, cardiac ischemia and chest
pain, the most common symptom of ACS.
ACS is divided into three categories: - Correct Answers-unstable angina (USA)
Non ST segment elevation MI (NSTEMI)
ST segment elevation MI (STEMI).
unstable angina (USA) - Correct Answers-no rise in cardiac biomarkers. If there is a
decrease in left ventricular function secondary to cardiac ischemia, it returns to normal
after the ischemia has resolved.
Non-STEMI
No evidence of ST elevation. - Correct Answers-Cardiac biomarker levels rise but the
levels will not be high enough to render a positive test result. May be left ventricular
dysfunction after NSTEMI resolves
STEMI - Correct Answers-ST elevations will be present in different leads depending on
injury location; a Q wave may be present. CK-MB and troponin are positive; high risk for
left ventricular dysfunction.
Risk factors for ACS include: - Correct Answers-CAD, atherosclerotic plaque on the
walls of the arteries; age >55, Male; smoking, obesity, HTN, ETOH,
hypercholesterolemia, sedentary lifestyle; uncontrolled DM
Myocardial ischemia is characterized by - Correct Answers-T-wave inversion on an
ECG.
Infarction is characterized by a Q wave duration of 0.04 seconds or longer. - Correct
Answers-The Q wave will also be approximately one-fourth to one-third the height of the
R wave.
, 40% to 50% of MIs involve the INFERIOR WALL - Correct Answers-In 80% of patients,
the inferior wall is supplied by the RCA via the posterior descending artery (Right-
dominance).
Good prognosis (<10% mortality)
40% to 50% of MIs involve the INFERIOR WALL - Correct Answers-In the other 20%,
the posterior descending artery is a branch of the circumflex artery (Left-dominance).
40% of INFERIOR WALL MIs involve the RIGHT VENTRICLE - Correct Answers-worse
outcome
hypotension, bradycardia, heart block, and cardiogenic shock
Bradycardias, heart blocks and arrhythmias associated with inferior wall MIs - Correct
Answers-The right coronary artery perfuses the sinoatrial node and AV node.
Most common ECG finding with inferior wall MI - Correct Answers-ST elevation in II, III
and aVF Reciprocal ST depression in lead aVL.
If right ventricular involvement suspected - Correct Answers-Performed a "right-sided
EKG" by reversing the precordial leads to the right side of the chest in a mirror image of
the traditional precordial leads.
Suspect right ventricular infarction in ALL inferior wall MIs. Do a right-sided EKG... -
Correct Answers-ST elevations is V3R-V6R confirms right ventricular MI
In patients presenting with inferior wall MI, right ventricular infarction is suggested by the
presence of: - Correct Answers-ST elevation in V1 (the only lead that looks directly at
the right ventricle).
Plus
ST depression in V2 (= highly specific for RV MI).
The ECG findings in occlusion of circumflex artery or branch from the LAD artery -
Correct Answers-ST elevations in leads I and aVL,
Reciprocal changes in V1 and V3.
POSTERIOR wall MI - Correct Answers-Occlusion in posterior descending artery — a
branch of the RCA.
May see inferior MI at same time due to shared blood supply.
The ECG findings in POSTERIOR wall MI - Correct Answers-ST Depression in V1-V4
ST elevation in V7-V9 (posterior EKG)
The ECG findings in POSTERIOR wall MI - Correct Answers-If R wave > S wave in V1
and V2, possible occlusion in RCA or circumflex artery.
