CVRN BC CORRECT EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔Why are diabetics 50% more likely to die from angina? - ✔✔They have nerve
damage and cannot feel the angina pain
✔✔Atypical angina or MI symptoms include - ✔✔dyspnea, unusual fatigue, absence of
classic CP
✔✔Three most common patterns suggestive of MI on serial EKGs - ✔✔Horizontal ST-T
depression
Down-sloping ST-T segment
T wave inversions
✔✔Most commonly reported symptoms of MI in women - ✔✔unusual fatigue
sleep disturbances
SOB
✔✔PCI Hospital goal - ✔✔90 mins door to balloon
✔✔Non PCI hospital goal - ✔✔if PCI delay >120 mins, fibrinolysis
✔✔Acute MI diagnostic criteria is rapid rise or fall of troponin plus one additional factor...
- ✔✔Symptoms of infarction
ECG changes consistent with MI
New pathological Q waves
Imaging evidence of new wall motion abnormality/ new loss of viability
✔✔When is an 18 lead EKG needed? - ✔✔If EKG is not diagnostic for an obvious
STEMI but pt is symptomatic because 18 lead shows inferior wall/posterior heart issues
✔✔Serial EKGs are needed when? - ✔✔If first EKG is nondiagnostic of MI but there is
high suspicion. Obtain EKG Q5-10 mins.
,✔✔CK-Total consists of - ✔✔CK-MM (muscle), CK-BB (brain), CK-MB (heart)
✔✔CK-Total rises, peaks and returns to normal when? - ✔✔Rises 5-6 hrs, Peaks 19-24
hrs, Normal 48-72 hrs
✔✔CK-Total normal level - ✔✔8-125 U/L
✔✔Troponin I normal level - ✔✔<10 ug/L
✔✔Troponin I rise, peak, return to normal - ✔✔rises 4 hrs, peaks 24 hrs, returns to
normal 5-10 days
✔✔Acute anteroseptal MI shows ST elevation in what leads? - ✔✔V1-V4
✔✔Late presentation (after 12 hours) STEMI s/sx - ✔✔EKG may show signs of active
necrosis in Q waves, ST elevation usually present, cardiac enzymes down trending.
✔✔Late presentation STEMI puts pt at higher risk for - ✔✔complications
✔✔NSTEMI EKG findings - ✔✔ST depression and T wave inversion
✔✔TIMI flow - ✔✔angiographic reference to the blood flow through the coronary vessel
✔✔TIMI 0 - ✔✔no blood flow
✔✔TIMI I - ✔✔sluggish blood flow
✔✔TIMI II - ✔✔moderate blood flow
✔✔TIMI III - ✔✔brisk flow
✔✔TIMI score? What does it indicate? - ✔✔The TIMI score is a risk of having an MI or
death in pt. with unstable angina or NSTEMI within 14 days.
Urgent Catheterization needed:
Age > 65
Markers elevated (cardiac enzymes)
EKG (ST depression 0.5 mm)
Risk factors (3+ risk factors for CAD)
Ischemia (2+ anginal events in last 24 hours
Known coronary stenosis of 50% or more
The TIMI stratifies which patients will benefit with a GIIb/IIIa inhibitor + early PCI
, ✔✔isosorbide mononitrate (Imdur) - ✔✔for ACS
✔✔Isosorbide dinitrate (Isordil) - ✔✔for HTN
✔✔MONA for CP mgmt - ✔✔Monitor - EKG 12 lead
Oxygen - 4L/min
NTG, MS - pain relief
ASA 160-325 mg
✔✔How to obtain 18 lead EKG - ✔✔Use a standard 12 lead machine, first run the 12
lead EKG, then rearrange the leads as follows:
Move V4 to V7 - left side posterior 3rd rib, MAL
Move V5 to V8 - left side posterior 5th ICS, posterior axillary line, just to the right of V7
Move V6 to V9 - Left side posterior rib 6th ICS, just to the right of V8, left paraspinal
area
Be sure to re-label leads V1-V3 as V4R, V5R, V6R, and relabel V4-V6 as V7, V8, V9.
✔✔Reciprocal changes - ✔✔mirror image changes in other leads
✔✔Indicative changes - ✔✔seen in leads facing damaged tissue
✔✔40% of inferior wall injuries have what - ✔✔RV infarcts, need 18 lead EKG
✔✔Infero-right ventricular infarction involves what artery - ✔✔RCA
✔✔Infero-right ventricular infarction involves ST elevation in what leads - ✔✔II, III, V1
✔✔Main complications of unmanaged HTN - ✔✔Brain - strokes/CVA
Blood - elevated BG levels
Retina - retinopathy
Heart - MI, HTN cardiomyopathy leading to HF
Kidneys - HTN neuropathy leading to chronic renal failure (give ACEI to protect kidneys)
✔✔Causes of secondary HTN - ✔✔Thyroid problems (hyper and hypo)
Hyperparathyroidism (regulates Ca+ and Phos, with too much hormone, Ca+ increases
and triggers HTN)
✔✔HTN crisis is umbrella term for - ✔✔HTN urgency
HTN emergency
✔✔HTN urgency - ✔✔BP 180/110 or greater.
No end organ issues or symptoms.
QUESTIONS SET A+
✔✔Why are diabetics 50% more likely to die from angina? - ✔✔They have nerve
damage and cannot feel the angina pain
✔✔Atypical angina or MI symptoms include - ✔✔dyspnea, unusual fatigue, absence of
classic CP
✔✔Three most common patterns suggestive of MI on serial EKGs - ✔✔Horizontal ST-T
depression
Down-sloping ST-T segment
T wave inversions
✔✔Most commonly reported symptoms of MI in women - ✔✔unusual fatigue
sleep disturbances
SOB
✔✔PCI Hospital goal - ✔✔90 mins door to balloon
✔✔Non PCI hospital goal - ✔✔if PCI delay >120 mins, fibrinolysis
✔✔Acute MI diagnostic criteria is rapid rise or fall of troponin plus one additional factor...
- ✔✔Symptoms of infarction
ECG changes consistent with MI
New pathological Q waves
Imaging evidence of new wall motion abnormality/ new loss of viability
✔✔When is an 18 lead EKG needed? - ✔✔If EKG is not diagnostic for an obvious
STEMI but pt is symptomatic because 18 lead shows inferior wall/posterior heart issues
✔✔Serial EKGs are needed when? - ✔✔If first EKG is nondiagnostic of MI but there is
high suspicion. Obtain EKG Q5-10 mins.
,✔✔CK-Total consists of - ✔✔CK-MM (muscle), CK-BB (brain), CK-MB (heart)
✔✔CK-Total rises, peaks and returns to normal when? - ✔✔Rises 5-6 hrs, Peaks 19-24
hrs, Normal 48-72 hrs
✔✔CK-Total normal level - ✔✔8-125 U/L
✔✔Troponin I normal level - ✔✔<10 ug/L
✔✔Troponin I rise, peak, return to normal - ✔✔rises 4 hrs, peaks 24 hrs, returns to
normal 5-10 days
✔✔Acute anteroseptal MI shows ST elevation in what leads? - ✔✔V1-V4
✔✔Late presentation (after 12 hours) STEMI s/sx - ✔✔EKG may show signs of active
necrosis in Q waves, ST elevation usually present, cardiac enzymes down trending.
✔✔Late presentation STEMI puts pt at higher risk for - ✔✔complications
✔✔NSTEMI EKG findings - ✔✔ST depression and T wave inversion
✔✔TIMI flow - ✔✔angiographic reference to the blood flow through the coronary vessel
✔✔TIMI 0 - ✔✔no blood flow
✔✔TIMI I - ✔✔sluggish blood flow
✔✔TIMI II - ✔✔moderate blood flow
✔✔TIMI III - ✔✔brisk flow
✔✔TIMI score? What does it indicate? - ✔✔The TIMI score is a risk of having an MI or
death in pt. with unstable angina or NSTEMI within 14 days.
Urgent Catheterization needed:
Age > 65
Markers elevated (cardiac enzymes)
EKG (ST depression 0.5 mm)
Risk factors (3+ risk factors for CAD)
Ischemia (2+ anginal events in last 24 hours
Known coronary stenosis of 50% or more
The TIMI stratifies which patients will benefit with a GIIb/IIIa inhibitor + early PCI
, ✔✔isosorbide mononitrate (Imdur) - ✔✔for ACS
✔✔Isosorbide dinitrate (Isordil) - ✔✔for HTN
✔✔MONA for CP mgmt - ✔✔Monitor - EKG 12 lead
Oxygen - 4L/min
NTG, MS - pain relief
ASA 160-325 mg
✔✔How to obtain 18 lead EKG - ✔✔Use a standard 12 lead machine, first run the 12
lead EKG, then rearrange the leads as follows:
Move V4 to V7 - left side posterior 3rd rib, MAL
Move V5 to V8 - left side posterior 5th ICS, posterior axillary line, just to the right of V7
Move V6 to V9 - Left side posterior rib 6th ICS, just to the right of V8, left paraspinal
area
Be sure to re-label leads V1-V3 as V4R, V5R, V6R, and relabel V4-V6 as V7, V8, V9.
✔✔Reciprocal changes - ✔✔mirror image changes in other leads
✔✔Indicative changes - ✔✔seen in leads facing damaged tissue
✔✔40% of inferior wall injuries have what - ✔✔RV infarcts, need 18 lead EKG
✔✔Infero-right ventricular infarction involves what artery - ✔✔RCA
✔✔Infero-right ventricular infarction involves ST elevation in what leads - ✔✔II, III, V1
✔✔Main complications of unmanaged HTN - ✔✔Brain - strokes/CVA
Blood - elevated BG levels
Retina - retinopathy
Heart - MI, HTN cardiomyopathy leading to HF
Kidneys - HTN neuropathy leading to chronic renal failure (give ACEI to protect kidneys)
✔✔Causes of secondary HTN - ✔✔Thyroid problems (hyper and hypo)
Hyperparathyroidism (regulates Ca+ and Phos, with too much hormone, Ca+ increases
and triggers HTN)
✔✔HTN crisis is umbrella term for - ✔✔HTN urgency
HTN emergency
✔✔HTN urgency - ✔✔BP 180/110 or greater.
No end organ issues or symptoms.
