- You believe your patient is presenting with an acute myocardial infarction, which one of these signs or symptoms would not be true for an MI?
A. ST-elevation seen in all leads
B. Chest-pressure radiating to right arm
C. Dyspnea
D. Nausea and diaphoresis
Rationale: The correct answer would be ST elevation seen in all leads. Diffuse ST-segment elevation is seen with acute pericarditis (McCance and Huether 2019, p. 1088). Depending on the region of the heart affected by the MI a twelve lead EKG will help identify the ischemic area through specific localized ST segment changes and T-waves(McCance and Huether 2019, p. 1086). Chest pressure, dyspnea, nausea, and diaphoresis are all symptoms associated with an acute MI.
2. Your 62-year-old female patient has just been diagnosed with an MI, she had a stent placed to the RCA. She states she is feeling fine and would like to discharge home now. You educate her on the necessity to stay for observation of what common complication?
A. Cardiac tamponade
B. Dysrhythmia
C. Endocarditis
D. Pulmonary emboli
Rationale: The most common complication of an acute MI is disturbances of cardiac rhythm or dysrhythmias (McCance and Huether 2019, p. 1087). The ischemia occurring with MI decreases blood flow to areas of the conduction system which can cause arrhythmias (McCance and Huether 2019, p. 1087). Tamponade can be a complication of pericardial effusion, endocarditis is an inflammation of the endocardium and is often a result of infectious causes (Berkowitz, 2007). Pulmonary emboli is caused by a thrombus, this is often associated with atrial fibrillation or other hypercoagulable states.
3. You order lab tests on a patient presenting with complaints of chest pain for 6 hours. Which of the following abnormal values would you expect to see if the patient’s chest pain is cardiac related?
A. Low potassium of 3.1
B. Elevated troponin of 4.5
C. Low hemoglobin of 7.3
D. Low glucose of 65
Rationale: Elevated troponin should be obtained on presentation to emergency room, it is the most specific indicator of MI and is detectable in blood 2 to 4 hours after onset of symptoms (McCance and Huether 2019, p. 1086). The other lab values are not consistent with MI.
4. Based on the following options which modifiable risk factors place your patient at increased risk for MI?
A. Age of 65
B. Smoking history of 3 packs per day for 30 years
C. Male
D. Vigorous exercise 3 times a week
Rationale: Age of 65 and Male do place you at an increased risk for MI but those are both non-modifiable risk factors. Cigarette smoking has a direct effect on the endothelial cells and the generation of oxygen radicals that contribute to atherogenesis. Nicotine stimulates the release of catecholamines, which increases heart rate and causes peripheral vascular constriction (McCance and Huether 2019, p. 1077). Exercise would decrease your risk of MI, physical activity and weight loss reduce risk of CAD.
5. Which of the following statements is CORRECT?
A. Myocardial tissue necrosis occurs immediately when blood flow is occluded.
B. Cardiac troponin is highest 30 minutes after infarction.
C. Inflammatory biomarkers are often elevated after an acute MI.
D. Chest pain is always present in myocardial infarctions.
Rationale: The correct answer is C. Clinical lab results can show leukocytosis and elevated CRP, indicating inflammation (McCance and Huether 2019, p. 1086). Myocardial tissue necrosis typically occurs after 20 minutes of ischemia, not immediately (McCance and Huether 2019, p. 1085). Cardiac troponin elevation is usually not detectable until 2-4 hours after onset of symptoms (McCance and Huether 2019, p. 1086). Chest pain is not always present during acute myocardial infarctions, some adults can have “silent” infarctions and experience no pain (McCance and Huether 2019, p. 1085).