NHA CCMA MAIN EXAMINATION CORE
QUESTIONS AND ANSWERS SURE A+
✔✔Third Degree Block's Characteristics - ✔✔-Atrial rate is greater than ventricular rate
-P waves are normal, there are no measurable PR intervals
-The atrial rhythm (P waves) is regular;AND the ventricular rhythm is regular (QRS
complexes)
-There is no relationship between P waves and QRS complexes
-If the escape rhythm is ventricular, the QRS complexes will be abnormally wide with a
slower ventricular rate
✔✔Define Ischemia - ✔✔Insufficient blood supply to the myocardium. Atherosclerosis of
the coronary arteries is the most common cause of the blood supply reduction.
✔✔Define Myocardial Infarction MI - ✔✔Sudden death of the myocardial tissue due to
an abrupt cessation of the blood flow. Clotting and total obstruction of a coronary artery
are frequently superimposed on an already narrowed vessel from atherosclerosis.
✔✔_____ ischemic injury is manifested by ST segment depression in the leads
recording in front of the ischemic site. - ✔✔Subendocardial
✔✔_____ and _____ injury is manifested by ST segment elevation in the leads
recording in front of the lesion. - ✔✔Subepicardial and Transmural
,✔✔Myocardial Infarction Characteristics - ✔✔-Marked ST elevation with hyperacute T
waves reflect complete muscular wall damage
-In later stages (sub-acute MI) deep Q waves are seen on the leads facing the lesion
manifesting necrosis
-Pathological Q waves and inverted T waves are signs of fibrosis and scar tissue
formation
It is an Emergency. Notify The Doctor.
✔✔Whats does WHO stand for? - ✔✔World Health Organization
✔✔The World Health Organization criteria for the diagnosis of myocardial infarction are
the presence of at least two of: - ✔✔-Clinical history of ischemic-type of chest
discomfort
-Changes on serial EKG tracings
-Rise and fall in serum cardiac markers demonstrating cardiac tissue damage
✔✔Define Artifact - ✔✔An unwanted interference or jitter on the EKG recording. This
makes the EKG reading difficult or impossible, as well as can lead to a misdiagnosis.
✔✔Define Somatic Tremor - ✔✔It is a jittery pattern caused by the patient's shivering or
by shaking wires. Help the patient relax, cover the patient, make sure that the wires are
correctly placed, or try the examination two more times. Redo the EKG until the tracing
is more readable.
✔✔Define Wandering Baseline - ✔✔Is it when the baseline moves up and down on the
EKG paper. It is often caused by lotion or sweat on the skin interfering with the signal
transmitted to the machine. Cleaning the site of the electrode and properly placing it
resolves the interference.
✔✔60-cycle Interference - ✔✔Cause by improperly grounded electrical equipment that
is directly or indirectly in contact with the patient. Cellular phones and pagers may also
interfere with the EKG trace. Disconnect and remove all the electric objects from the
patient or near by the machine.
✔✔Broken Recording - ✔✔Can be caused by a damaged wire or loose electrodes. If
the probes are placed properly, the cause is origination from a broken or damaged wire.
Use a different EKG machine or replace the wires. Never use a damaged or
malfunctioning machine.
✔✔Stress Testing - ✔✔Is a noninvasive diagnostic procedure indirectly, the presence
and severity of coronary artery disease and the heart muscle lack of blood supply.
✔✔Stress test is performed through _____ or _____ while hooked up to an EKG
monitor. The limb leads are applied to the torso of the patient rather than on the
, extremities. - ✔✔Exercise (by having the patient walk on a treadmill or by pedaling on a
bicycle)
Pharmacologically (by administration of medication that causes increase in heart rate)
✔✔Exercise Stress Test - ✔✔This test is performed until at least 85% of the target heart
rate is reached or symptoms or EKG changes develop which requires the test to be
terminated. Target heart rate is 220 minus patient's age.
✔✔Pharmacologic Stress Test - ✔✔This test is appropriate for patients with physical
limitation. Medications such as adenosine, dipyridamole, or dobutamine are given
intravenously through an IV line to cause the heart rate to climb to the target level or the
same symptoms and EKG changes as the exercise test develop. The test is concluded
after 85% of the target heart rate is achieved.
✔✔Ambulatory EKG Monitoring - ✔✔Is mainly, but not only, used for diagnosis of
cardiac dysrhythmias (disorders of the heart rhythm). It can also evaluate the heart rate,
rhythm and function during daily activities.
✔✔Holter Monitor - ✔✔This is an ambulatory EKG done to rule out intermittent
arrhythmia or ischemia that could be missed on a a routine EKG.
5 electrode are attached to the patient's trunk instead on the arms and leg to prevent
muscle artifact.
✔✔Typical Electrode Placement for Holter monitoring: - ✔✔-2 exploring electrodes are
placed over bone (to minimize motion artifact) near the V1 (over the 4th or 5th rib to the
right of the sternum) and V5 (over the 5th rib at the left midaxillary line)
-2 indifferent electrodes placed over the sternal head
-One ground electrode placed over the 9th or 10th rib at the right midaxillary line
✔✔Recording artifacts can result from the following:
-With an analog system - ✔✔Incomplete tape erasure - this can result in EKG tracings
belonging to two different patients confounding both the scanner and the interpreter.
Tape drag within the apparatus - this will result in recording of spuriously rapid cardiac
rhythms. A narrowing of all EKG complexes and intervals should give clue to this
situation.
✔✔Recording artifacts can result from the following:
-Battery Depletion - ✔✔This may result in varying QRS amplitude
✔✔Recording artifacts can result from the following:
-Loose Connection - ✔✔Intermittently loose connection in the insertion of the electrodes
into the recording apparatus can result in the absence of all EKG signals which may
mimic bradycardia-tachycardia syndrome. Clue to this artifact is the attenuated QRST
morphology of the complexes beginning and ending the pause in rhythm.
QUESTIONS AND ANSWERS SURE A+
✔✔Third Degree Block's Characteristics - ✔✔-Atrial rate is greater than ventricular rate
-P waves are normal, there are no measurable PR intervals
-The atrial rhythm (P waves) is regular;AND the ventricular rhythm is regular (QRS
complexes)
-There is no relationship between P waves and QRS complexes
-If the escape rhythm is ventricular, the QRS complexes will be abnormally wide with a
slower ventricular rate
✔✔Define Ischemia - ✔✔Insufficient blood supply to the myocardium. Atherosclerosis of
the coronary arteries is the most common cause of the blood supply reduction.
✔✔Define Myocardial Infarction MI - ✔✔Sudden death of the myocardial tissue due to
an abrupt cessation of the blood flow. Clotting and total obstruction of a coronary artery
are frequently superimposed on an already narrowed vessel from atherosclerosis.
✔✔_____ ischemic injury is manifested by ST segment depression in the leads
recording in front of the ischemic site. - ✔✔Subendocardial
✔✔_____ and _____ injury is manifested by ST segment elevation in the leads
recording in front of the lesion. - ✔✔Subepicardial and Transmural
,✔✔Myocardial Infarction Characteristics - ✔✔-Marked ST elevation with hyperacute T
waves reflect complete muscular wall damage
-In later stages (sub-acute MI) deep Q waves are seen on the leads facing the lesion
manifesting necrosis
-Pathological Q waves and inverted T waves are signs of fibrosis and scar tissue
formation
It is an Emergency. Notify The Doctor.
✔✔Whats does WHO stand for? - ✔✔World Health Organization
✔✔The World Health Organization criteria for the diagnosis of myocardial infarction are
the presence of at least two of: - ✔✔-Clinical history of ischemic-type of chest
discomfort
-Changes on serial EKG tracings
-Rise and fall in serum cardiac markers demonstrating cardiac tissue damage
✔✔Define Artifact - ✔✔An unwanted interference or jitter on the EKG recording. This
makes the EKG reading difficult or impossible, as well as can lead to a misdiagnosis.
✔✔Define Somatic Tremor - ✔✔It is a jittery pattern caused by the patient's shivering or
by shaking wires. Help the patient relax, cover the patient, make sure that the wires are
correctly placed, or try the examination two more times. Redo the EKG until the tracing
is more readable.
✔✔Define Wandering Baseline - ✔✔Is it when the baseline moves up and down on the
EKG paper. It is often caused by lotion or sweat on the skin interfering with the signal
transmitted to the machine. Cleaning the site of the electrode and properly placing it
resolves the interference.
✔✔60-cycle Interference - ✔✔Cause by improperly grounded electrical equipment that
is directly or indirectly in contact with the patient. Cellular phones and pagers may also
interfere with the EKG trace. Disconnect and remove all the electric objects from the
patient or near by the machine.
✔✔Broken Recording - ✔✔Can be caused by a damaged wire or loose electrodes. If
the probes are placed properly, the cause is origination from a broken or damaged wire.
Use a different EKG machine or replace the wires. Never use a damaged or
malfunctioning machine.
✔✔Stress Testing - ✔✔Is a noninvasive diagnostic procedure indirectly, the presence
and severity of coronary artery disease and the heart muscle lack of blood supply.
✔✔Stress test is performed through _____ or _____ while hooked up to an EKG
monitor. The limb leads are applied to the torso of the patient rather than on the
, extremities. - ✔✔Exercise (by having the patient walk on a treadmill or by pedaling on a
bicycle)
Pharmacologically (by administration of medication that causes increase in heart rate)
✔✔Exercise Stress Test - ✔✔This test is performed until at least 85% of the target heart
rate is reached or symptoms or EKG changes develop which requires the test to be
terminated. Target heart rate is 220 minus patient's age.
✔✔Pharmacologic Stress Test - ✔✔This test is appropriate for patients with physical
limitation. Medications such as adenosine, dipyridamole, or dobutamine are given
intravenously through an IV line to cause the heart rate to climb to the target level or the
same symptoms and EKG changes as the exercise test develop. The test is concluded
after 85% of the target heart rate is achieved.
✔✔Ambulatory EKG Monitoring - ✔✔Is mainly, but not only, used for diagnosis of
cardiac dysrhythmias (disorders of the heart rhythm). It can also evaluate the heart rate,
rhythm and function during daily activities.
✔✔Holter Monitor - ✔✔This is an ambulatory EKG done to rule out intermittent
arrhythmia or ischemia that could be missed on a a routine EKG.
5 electrode are attached to the patient's trunk instead on the arms and leg to prevent
muscle artifact.
✔✔Typical Electrode Placement for Holter monitoring: - ✔✔-2 exploring electrodes are
placed over bone (to minimize motion artifact) near the V1 (over the 4th or 5th rib to the
right of the sternum) and V5 (over the 5th rib at the left midaxillary line)
-2 indifferent electrodes placed over the sternal head
-One ground electrode placed over the 9th or 10th rib at the right midaxillary line
✔✔Recording artifacts can result from the following:
-With an analog system - ✔✔Incomplete tape erasure - this can result in EKG tracings
belonging to two different patients confounding both the scanner and the interpreter.
Tape drag within the apparatus - this will result in recording of spuriously rapid cardiac
rhythms. A narrowing of all EKG complexes and intervals should give clue to this
situation.
✔✔Recording artifacts can result from the following:
-Battery Depletion - ✔✔This may result in varying QRS amplitude
✔✔Recording artifacts can result from the following:
-Loose Connection - ✔✔Intermittently loose connection in the insertion of the electrodes
into the recording apparatus can result in the absence of all EKG signals which may
mimic bradycardia-tachycardia syndrome. Clue to this artifact is the attenuated QRST
morphology of the complexes beginning and ending the pause in rhythm.
