You are in the Emergency Department when a 54 year old male arrives rubbing the center of his chest. He states “it feel like someone is sitting on my chest.” He appears pale and his skin is diaphoretic. His radial pulse is strong, but fast. Blood pressure is 130/80 with a pulse ox of 90% on room air. He has no past medical history and takes no medications except for Tylenol for an occasional headache. He has no allergies. You take him back to a room, place on the monitor and gain IV access.
His monitor strip is as follows. src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Question_1.jpg This rhythm is?
Third Degree Heart Block
Normal Sinus Rhythm
2) Although the patient is not short of breath, he should receive oxygen because
He is hypoxic
Third Degree Heart Block
Normal Sinus Rhythm
3) Early signs and symptoms of Acute Coronary Syndrome (ACS) – MI or Heart Attack include:
Pressure – fullness, squeezing, or pain in the center of the chest lasting several minutes (usually more than 15 minutes)
Pain – spreading to the shoulders, neck, arms, or jaw, or pain in the back or between the shoulder blades
Other symptoms: weakness, dizziness, sweating, N/V, uneasiness, dyspnea; distress, anxiety, or sense of impending doom
ALL of these are signs and symptoms of Acute Coronary Syndrome/MI or Heart Attack
4) Women may NOT exhibit typical signs and symptoms of ACS. Which of the following heart attack symptoms is LESS common in women?
Shortness of breath
Profound sense of fatigue/flu-like discomfort
Indigestion or heartburn
Sudden onset of crushing chest pressure
5) The next priority in his assessment (within 10 minutes of arrival) is
Obtain a 12 lead ECG and have it interpreted by a physician.
Exercise stress test
Portable chest X-ray
6) You complete a 12 Lead ECG which reveals: src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Q_6.jpg
Bundle branch block
7) This patient most likely has experienced an
Occlusion of a carotid artery
Occlusion of a coronary vein
Occlusion of a coronary artery
Occlusion of a peripheral artery
8) What should you do next?
Wait and see if the patient improves.
Place the ECG in the chart.
Activate a Code STEMI by dialing X22222 and saying “911 STAT Cardiology Consult.”
Look for a Resident or Attending
9) Which medication(s) should be given immediately upon diagnosis of myocardial infarction?
Dual antiplatelet therapy such as Aspirin and Ticagrelor
10) Nitroglycerin is administered to this patient without pain relief. He continues to complain of chest pain that he rates as an 8/10. He is obviously uncomfortable. Which type of medication should be given to relieve the pain of myocardial infarction?
Narcotics such as Morphine, Fentanyl
Calcium Channel Blockers such as Diltiazem
Beta blockers such as Lopressor
Statins such as Lipitor
11) Which of the following Lab tests are important to the diagnosis of Acute MI?
Complete blood count
Lactic Acid level
12) This patient should be prepared to be emergently transported to?
Radiology for a CT scan
The cardiac catheterization lab
The cardiac telemetry unit
The ICU/coronary care unit
13) What is the goal from patient symptom onset to restoring blood flow to the coronary artery?
There are no goals
The amount of time the vessel remains blocked does not affect patient outcomes
14) The size of this patient’s infarction (amount of myocardium that dies) is what will determine how well he does into the future (mortality). The size of his infarction is dependent upon
LDL levels at discharge.
Amount of time it takes to get a beta blocker.
Length of time until the vessel is opened and flow is restored.
15) As you are preparing the patient for transport, he suddenly becomes dizzy and feels as if he is going to pass out. You follow protocol and the patient is currently on a transport cardiac monitor which reveals Sinus Bradycardia at a rate of 32. His blood pressure is now 70/50 and his pulse oximetry is 96%. IV access was obtained earlier. You should
Administer Epinephrine 1mg IVP.
Administer Amiodarone 150mg IVP.
Administer an additional 181mg of aspirin.
Administer Atropine 0.5mg IV.
16) There is no response to the administration of Atropine. Another option in the acute management of this patient is
17) After a successful percutaneous coronary intervention in which the patient received a coronary stent, he returns to the floor. Two hours later, your patient complains of chest pressure and shortness of breath. Assessment of his telemetry rhythm reveals Sinus Rhythm with frequent PVCs and ST segment elevation. Identify which the strip below exhibits ST segment elevation: src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Question_17.JPG
18) What do you do next?
Document the strip and place it in the chart.
Activate a Code Stroke
Call Pastoral Care
Immediately obtain a 12 lead ECG and activate Code STEMI process by dialing X22222 and saying “911 STAT Cardiology Consult.”
19) If you suspect your patient is having a MI, but are not sure, which course of action could be harmful?
Activating the Code STEMI process.
Notifying the physician.
Notifying your team leader or charge nurse.
Waiting one hour and see if things improve.
20) You would expect this patient to be discharged on
Cardizem, Digoxin, Beta Blocker and Verapamil
Beta Blocker, Ace Inhibitor, Aspirin and High intensity Statin
There are no guidelines or recommendations for patients with an acute MI.
Amiodarone, Lidocaine and Epinephrine
21) Modifiable risk factors for Heart Disease include ALL of the following, EXCEPT:
22) All Acute MI patient receive Cardiac Rehabilitation inpatient education because:
Cardiac rehab is most effective when introduced while in a hospital setting.
Cardiac rehab cuts the risk of repeat heart attacks by 15-20% by educating patients on modifiable risk factors.
Cardiac rehab participants have a 35% lower death rate than non-participants.
All of the above.
23) SSM SLUH STEMI Program information and resources can be found: