CCRN CARDIAC QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY
GRADED A+
Acute Coronary Syndrome (definition) - Correct answerSyndrome of acute
myocardial ischemia caused by atherosclerotic plaque rupture and thrombus formation
Acute Coronary Syndrome (etiology) - Correct answerSame as Coronary
Artery Dz, Angina Pectoris, and Myocardial Infarction
Coronary Artery Disease (definition) - Correct answerA progressive disease of
the coronary arteries that results in their narrowing of obstruction
CAD (pathophysiology) - Correct answer1.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 - Correct
answer1. Angina pectoris
2. MI
3. Heart failure
4. Dysrhythmias caused ischemia
5. Sudden death
Angina Pectoris (etiology) - Correct answerFactors 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) - Correct answer1.
Subjective
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) - Correct answera. Tachycardia
b. Hypotension or HTN
c. Tachypnea
d. Pallor
e. Diaphoresis
g. S4
Angina Pectoris (Diagnostic) - Correct answera. 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 - Correct answerStable and Unstable Angina
,Stable Angina (signs and symptoms) - Correct answer- Unchanging frequency,
duration, and severity
- Predictable to the patient
- ST segment depression may occur during pain
Angina Pectoris (Collaborative Management) - Correct answer1. 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
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) - Correct answerPTCA
(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) - Correct answerUnstable 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) - Correct answerLeft main CAD (unless there is a
patent bypass around it, referred to as protected)
Stenosis of coronary artery at orifice
Variant angina
Myocardial Infarction - Correct answerDeath of a portion of the myocardium
MI (etiology) - Correct answerMost 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) - Correct answerAtherosclerosis with unstable plaque
Plaque rupture may be caused by inflammation and/or infection
C-reactive protein (CRP) rises rapidly following an inflammatory response
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: - Correct answerExtensive anterior
V1 - V6
Sudden Cardiac death
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY
GRADED A+
Acute Coronary Syndrome (definition) - Correct answerSyndrome of acute
myocardial ischemia caused by atherosclerotic plaque rupture and thrombus formation
Acute Coronary Syndrome (etiology) - Correct answerSame as Coronary
Artery Dz, Angina Pectoris, and Myocardial Infarction
Coronary Artery Disease (definition) - Correct answerA progressive disease of
the coronary arteries that results in their narrowing of obstruction
CAD (pathophysiology) - Correct answer1.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 - Correct
answer1. Angina pectoris
2. MI
3. Heart failure
4. Dysrhythmias caused ischemia
5. Sudden death
Angina Pectoris (etiology) - Correct answerFactors 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) - Correct answer1.
Subjective
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) - Correct answera. Tachycardia
b. Hypotension or HTN
c. Tachypnea
d. Pallor
e. Diaphoresis
g. S4
Angina Pectoris (Diagnostic) - Correct answera. 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 - Correct answerStable and Unstable Angina
,Stable Angina (signs and symptoms) - Correct answer- Unchanging frequency,
duration, and severity
- Predictable to the patient
- ST segment depression may occur during pain
Angina Pectoris (Collaborative Management) - Correct answer1. 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
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) - Correct answerPTCA
(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) - Correct answerUnstable 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) - Correct answerLeft main CAD (unless there is a
patent bypass around it, referred to as protected)
Stenosis of coronary artery at orifice
Variant angina
Myocardial Infarction - Correct answerDeath of a portion of the myocardium
MI (etiology) - Correct answerMost 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) - Correct answerAtherosclerosis with unstable plaque
Plaque rupture may be caused by inflammation and/or infection
C-reactive protein (CRP) rises rapidly following an inflammatory response
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: - Correct answerExtensive anterior
V1 - V6
Sudden Cardiac death
