CARDIAC + CCRN EXAM QUESTIONS WITH 100% VERIFIED ANSWERS
Acute Coronary Syndrome (definition) - ANSWER Syndrome of acute myocardial ischemia caused
by atherosclerotic plaque rupture and thrombus formation
Acute Coronary Syndrome (etiology) - ANSWER Same as Coronary Artery Dz, Angina Pectoris, and
Myocardial Infarction
Coronary Artery Disease (definition) - ANSWER A progressive disease of the coronary arteries that
results in their narrowing of obstruction
CAD (pathophysiology) - ANSWER 1.Arteriosclerosis: a group of diseases characterized by
thickening and loss of elasticity (calcification) of arterial walls
2. Atherosclerosis: the most common form of arteriosclerosis.
a. A chronic disease process characterized by the build-up of fatty plague along the subintimal layer
of arteries leading to a decrease in arterial luman.
3. Decreased blood flow and oxygen supply to the myocardium lead to imbalance between oxygen
supply and oxygen demand.
a. Gradual or partial occlusion: ischemia causing angina
b. Sudden or complete occlusion: necrosis causing MI
Pathologic Consequence of Atherosclerosis and Arteriosclerosis - ANSWER 1. Angina pectoris
2. MI
3. Heart failure
4. Dysrhythmias caused ischemia
5. Sudden death
Angina Pectoris (etiology) - ANSWER Factors that decrease supply
a. Arteriosclerosis/atherosclerosis
b. Coronary artery spasm
c. Aortitis
d. Dysrhythmias
e. Anemia
f. Shock
Factors that increase demand:
a. HTN
b. Aortic valve dz
c. Tachydysrhythmias
d. HF
e. Hyperthyroidism
Angina Pectoris (clinical presentation - subjective) - ANSWER 1. Subjective
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,a. Substernal chest discomfort that usually lasts 1 to 4 minutes and subsides with rest and/or nitro use.
1. Discomfort may be described as burning, squeezing, tightness, pressure, heaviness, indigestion, or
aching.
2. Pain may radiate to shoulders, back, arms, jaw, neck, and epigastrium
b. Dyspnea
c. N/V
d. Anxiety
e. Weakness
Angina Pectoris (objective) - ANSWER a. Tachycardia
b. Hypotension or HTN
c. Tachypnea
d. Pallor
e. Diaphoresis
g. S4
Angina Pectoris (Diagnostic) - ANSWER a. Serum
1. Isoenzymes: negative for cardiac damage
2. Fasting glucose: to identify DM or glucose intolerance as a risk factor
b. ECG
1. ST segment depression in unstable angina
2. ST segment elevation in variant angina
3. Ventricular dysrhythmias may be present
c. Cardiac cauterization: coronary artery occlusion 75% or greater; may be negative in variant angina
but develop occlusion from spasm
Types of Angina - ANSWER Stable and Unstable Angina
Stable Angina (signs and symptoms) - ANSWER - Unchanging frequency, duration, and severity
- Predictable to the patient
- ST segment depression may occur during pain
Angina Pectoris (Collaborative Management) - ANSWER 1. Relieve chest pain
a. Nitro
b. Calcium channel blockers (especially for variant angina)
c. Morphine sulfate may be required for unstable angina
2. Increase oxygen demand
a. nasal canula 5L/min during ischemic pain unless contraindicated by lung dz.
b. Blood transfusion if angina caused by anemia
c. Platelet aggregation inhibitors (e.g., aspirin or ticlopidine to prevent platelet aggregation; heparin
may be prescribed to prevent clotting or extension of clot
d. IABP - may be used in unstable angina; IABP increases coronary artery perfusion pressure (CAPP)
3. Decrease oxygen demand
a. Removal of provoking factors
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,1. Activity cessation immediately when chest pain occurs
2. Bed rest during pain; semi-Fowler position usually most comfortable
b. NTG as prescribed
1. NTG in doses less than 1 mcg/kg/min is a predominately venous dilator (decreases after load and
preload as well); it decreases myocardial workload and myocardial oxygen consumption by
decreasing preload.
Percutaneous Coronary Intervention (procedures) - ANSWER PTCA (percutaneous transluminal
coronary angioplasty): inflation of a balloon-tipped catheter in an area of coronary artery stenosis
from plague; plague is pushed back against the wall of vessel and fractured (controlled trauma)
Coronary Artery Stent: Use of a metal that acts as a scaffolding device to support a coronary artery
and maintain potency after PTCA
Brachytherapy: use of intracoronary irradiation to reduce risk of restenosis
Coronary atherectomy: removal of plaque from coronary artery by a high-speed diamond tipped
(rotational) or shaving (directional) device
PCI (indications) - ANSWER Unstable or chronic angina
Acute or post acute MI
Post-CABG with postoperative angina
Patient must be surgical candidate (in case of coronary artery dissection)
PCI (contraindications) - ANSWER Left main CAD (unless there is a patent bypass around it,
referred to as protected)
Stenosis of coronary artery at orifice
Variant angina
Myocardial Infarction - ANSWER Death of a portion of the myocardium
MI (etiology) - ANSWER Most are caused by arteriosclerosis and thrombosis
Arteriosclerosis/atherosclerosis
Coronary artery thrombosis
Coronary artery spasm
Cocaine-induced: excessive sympathetic stimulation causes tachycardia, HTN, arterial
vasoconstriction, and spasm; coronary artery spasm may cause MI, especially non-Q wave infarction
MI (patho) - ANSWER Atherosclerosis with unstable plaque
Plaque rupture may be caused by inflammation and/or infection
C-reactive protein (CRP) rises rapidly following an inflammatory response
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, Inadequate oxygenation causes anaerobic metabolism - which causes lactic acidoses
Prolonged ischemic causes electrical and mechanical death of myocardium
Ischemia, injury, and acidosis causes electrical irritability; this potentially leads to PVCs, VT, VF
Left main coronary artery
Location:
ECG leads:
Complications: - ANSWER Extensive anterior
V1 - V6
Sudden Cardiac death
HF
Cariogenic shock
Left anterior descending artery
Location:
ECG leads:
Complications: - ANSWER Septal
V1 - V2
Sinus Tachy
AF
Anterior
V3 - V4
Ventricular aneurysm
HF
Cariogenic Shock
Left Circumflex Artery
Location:
ECG Leads:
Complications: - ANSWER Lateral
High: I, aVL
Low: V5, V6
Dysrhythmias
HF
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Acute Coronary Syndrome (definition) - ANSWER Syndrome of acute myocardial ischemia caused
by atherosclerotic plaque rupture and thrombus formation
Acute Coronary Syndrome (etiology) - ANSWER Same as Coronary Artery Dz, Angina Pectoris, and
Myocardial Infarction
Coronary Artery Disease (definition) - ANSWER A progressive disease of the coronary arteries that
results in their narrowing of obstruction
CAD (pathophysiology) - ANSWER 1.Arteriosclerosis: a group of diseases characterized by
thickening and loss of elasticity (calcification) of arterial walls
2. Atherosclerosis: the most common form of arteriosclerosis.
a. A chronic disease process characterized by the build-up of fatty plague along the subintimal layer
of arteries leading to a decrease in arterial luman.
3. Decreased blood flow and oxygen supply to the myocardium lead to imbalance between oxygen
supply and oxygen demand.
a. Gradual or partial occlusion: ischemia causing angina
b. Sudden or complete occlusion: necrosis causing MI
Pathologic Consequence of Atherosclerosis and Arteriosclerosis - ANSWER 1. Angina pectoris
2. MI
3. Heart failure
4. Dysrhythmias caused ischemia
5. Sudden death
Angina Pectoris (etiology) - ANSWER Factors that decrease supply
a. Arteriosclerosis/atherosclerosis
b. Coronary artery spasm
c. Aortitis
d. Dysrhythmias
e. Anemia
f. Shock
Factors that increase demand:
a. HTN
b. Aortic valve dz
c. Tachydysrhythmias
d. HF
e. Hyperthyroidism
Angina Pectoris (clinical presentation - subjective) - ANSWER 1. Subjective
Page 1 of 119
,a. Substernal chest discomfort that usually lasts 1 to 4 minutes and subsides with rest and/or nitro use.
1. Discomfort may be described as burning, squeezing, tightness, pressure, heaviness, indigestion, or
aching.
2. Pain may radiate to shoulders, back, arms, jaw, neck, and epigastrium
b. Dyspnea
c. N/V
d. Anxiety
e. Weakness
Angina Pectoris (objective) - ANSWER a. Tachycardia
b. Hypotension or HTN
c. Tachypnea
d. Pallor
e. Diaphoresis
g. S4
Angina Pectoris (Diagnostic) - ANSWER a. Serum
1. Isoenzymes: negative for cardiac damage
2. Fasting glucose: to identify DM or glucose intolerance as a risk factor
b. ECG
1. ST segment depression in unstable angina
2. ST segment elevation in variant angina
3. Ventricular dysrhythmias may be present
c. Cardiac cauterization: coronary artery occlusion 75% or greater; may be negative in variant angina
but develop occlusion from spasm
Types of Angina - ANSWER Stable and Unstable Angina
Stable Angina (signs and symptoms) - ANSWER - Unchanging frequency, duration, and severity
- Predictable to the patient
- ST segment depression may occur during pain
Angina Pectoris (Collaborative Management) - ANSWER 1. Relieve chest pain
a. Nitro
b. Calcium channel blockers (especially for variant angina)
c. Morphine sulfate may be required for unstable angina
2. Increase oxygen demand
a. nasal canula 5L/min during ischemic pain unless contraindicated by lung dz.
b. Blood transfusion if angina caused by anemia
c. Platelet aggregation inhibitors (e.g., aspirin or ticlopidine to prevent platelet aggregation; heparin
may be prescribed to prevent clotting or extension of clot
d. IABP - may be used in unstable angina; IABP increases coronary artery perfusion pressure (CAPP)
3. Decrease oxygen demand
a. Removal of provoking factors
Page 2 of 119
,1. Activity cessation immediately when chest pain occurs
2. Bed rest during pain; semi-Fowler position usually most comfortable
b. NTG as prescribed
1. NTG in doses less than 1 mcg/kg/min is a predominately venous dilator (decreases after load and
preload as well); it decreases myocardial workload and myocardial oxygen consumption by
decreasing preload.
Percutaneous Coronary Intervention (procedures) - ANSWER PTCA (percutaneous transluminal
coronary angioplasty): inflation of a balloon-tipped catheter in an area of coronary artery stenosis
from plague; plague is pushed back against the wall of vessel and fractured (controlled trauma)
Coronary Artery Stent: Use of a metal that acts as a scaffolding device to support a coronary artery
and maintain potency after PTCA
Brachytherapy: use of intracoronary irradiation to reduce risk of restenosis
Coronary atherectomy: removal of plaque from coronary artery by a high-speed diamond tipped
(rotational) or shaving (directional) device
PCI (indications) - ANSWER Unstable or chronic angina
Acute or post acute MI
Post-CABG with postoperative angina
Patient must be surgical candidate (in case of coronary artery dissection)
PCI (contraindications) - ANSWER Left main CAD (unless there is a patent bypass around it,
referred to as protected)
Stenosis of coronary artery at orifice
Variant angina
Myocardial Infarction - ANSWER Death of a portion of the myocardium
MI (etiology) - ANSWER Most are caused by arteriosclerosis and thrombosis
Arteriosclerosis/atherosclerosis
Coronary artery thrombosis
Coronary artery spasm
Cocaine-induced: excessive sympathetic stimulation causes tachycardia, HTN, arterial
vasoconstriction, and spasm; coronary artery spasm may cause MI, especially non-Q wave infarction
MI (patho) - ANSWER Atherosclerosis with unstable plaque
Plaque rupture may be caused by inflammation and/or infection
C-reactive protein (CRP) rises rapidly following an inflammatory response
Page 3 of 119
, Inadequate oxygenation causes anaerobic metabolism - which causes lactic acidoses
Prolonged ischemic causes electrical and mechanical death of myocardium
Ischemia, injury, and acidosis causes electrical irritability; this potentially leads to PVCs, VT, VF
Left main coronary artery
Location:
ECG leads:
Complications: - ANSWER Extensive anterior
V1 - V6
Sudden Cardiac death
HF
Cariogenic shock
Left anterior descending artery
Location:
ECG leads:
Complications: - ANSWER Septal
V1 - V2
Sinus Tachy
AF
Anterior
V3 - V4
Ventricular aneurysm
HF
Cariogenic Shock
Left Circumflex Artery
Location:
ECG Leads:
Complications: - ANSWER Lateral
High: I, aVL
Low: V5, V6
Dysrhythmias
HF
Page 4 of 119
