EMS Training Institute
Office: (219) 947-6874 or (219) 947-6347
Fax: (219)947-6119
1500 South Lake Park Avenue, Hobart, IN 46342
E- Continuing Education
March 2013- Cardiology
Due April 16, 2013
BLS portion:
2 hours
ALS portion: 4 hours
Complete packet:
6 hours
See Robert Boby, Jessica Lawley, Jeffrey Lawley, or Robert Scott for CEU signatures
Basic Life Support Research and Review
1. Oxygen deficient blood enters the right atrium via the __________ and __________ _______ _________.
2. From the right atrium, blood travels through the __________ valve into the ________ ____________.
3. From here, blood travels through the _____________ valve and to the lungs via pulmonary _________.
4. Pulmonary circulation become capillaries that surround _____________ where O2/CO2 exchange occur.
5. Blood returns to the heart via pulmonary ___________ and enters the ___________ ___________.
6. From here, blood passes through the ______________ valve into the ___________ ______________.
7. Leaving the heart, blood passes through the __________ valve into the __________.
8. The first branches off the aorta give rise to the __________ _________ which supply blood to the _______.
9. Explain “acute coronary syndrome.”
10. Define defibrillation:
11. _______________ is the term for a heart rate less than 60 bpm and ______________ for over 100 bpm.
12. Aspirin should be administered to any patient with suspected ACS, unless there are contraindications
present. The aspirin in your ambulance should be (circle one) enteric or non-enteric. Why?
13. It is within the EMT scope of practice to assist a patient experiencing ACS with their prescription for
nitroglycerine, with medical direction approval. What is the effect of nitroglycerin on the vasculature?
What changes may we see in the patient’s vital signs after NTG administration?
What is a common side effect of NTG administration that a patient may report?
14. Explain the origin of angina:
15. Define thrombus:
16. Define embolus:
17. Define aneurysm:
18. Define sudden death:
19. What are the links in the AHA chain of survival?
20. Ideally, defibrillation will occur within how many minutes of cardiac arrest for defibrillation to be
effective?
21. When in therapeutic hypothermia indicated?
22. How can an EMT initiate therapeutic hypothermia in the prehospital setting?
23. What two rhythms can an AED defibrillate?
26. Effective compressions occur at a rate of at least _____ per minute, and a depth of ___________ inches.
27. The _____________ node is the primary pacemaker for the heart with an intrinsic rate of ____________.
28. The _____________ node is the “back up” to #27, with an intrinsic rate of _____________.
29. The _________________ are the “back up” to #28, with an intrinsic rate of _____________.
30. List two “non-shockable” rhythms for the AED:
Advanced Life Support Research and Review
1. List four non-modifiable risk factors for cardiovascular disease:
a.
b.
a.
b.
3. Heavy alcohol intake (3+ drinks per day) increases risk of death from :a.
b.
c.
d.
2. List four modifiable risk factors for cardiovascular disease:
c.
d.
c.
d.
4. The base of the heart is lies at the ____ rib, and the apex is at the _______ ribs, just above the _________ (structure).
5. Define PMI:
Where is this located?
6.The outermost layer of the heart is the _____________ which contains: a.
c.
b.
d.
7. Define atrial kick:
8. ___% of blood passively fills the ventricles, while ____% enters the ventricles due to atrial kick.
9. What two rhythms commonly result in a loss of atrial kick?
10. Relating to the cardiac cycle, explain the following:
Systole:
Diastole:
11. The coronary arteries and myocardium fill during:
12. Where is the coronary sinus located?
What is it role?
Where does it drain?
13. Two vessels branch form the aorta to give rise to coronary circulation. Name them:
14. Which prehospital medication has a negative dromotropic effect?
15. List three prehospital medications in your drug box that have a positive inotropic effect:
a.
b.
c.
16. The _________ nerve is the primary parasympathetic nerve supply for the heart. Branches of its nerve enervate the:
a.
b.
c.
17. Norepinephrine is released by the ___________ ___________ , resulting in the following predictable results:
a.
b.
c.
18. End-diastolic volume is also known by what term?
19. Define afterload:
Afterload is affected by a.
b.
c.
20. Define polarization (polarized state):
21. Define depolarization:
22. Depolarization must occur prior to what cardiac function?
23. The heart depolarizes from __________________ to _________________ (layer of heart).
24. Define repolarization:
25. The heart repolarizes from __________________ to _________________ (layer of heart).
26. How does the sodium-potassium pump correlate to #21 and #24?
27. What concerns does a paramedic have relating to the relative refractory period and the supernormal period?
28. The RCA divides into the ___________________________ and _____________________ and supplies blood to the :
29. The LCA divides into the ___________________________ and _____________________ and supplies blood to the :
30. The LAD divides into the ___________________________ and _____________________ and supplies blood to the :
31. The circumflex divides into the ___________________________ and _____________________ and supplies blood to
the :
32. The SA node conducts impulses to the AV junction via __________ (how many) internodal pathways.
33. The AV junction contains the __________________________ and the _________________________.
34. Define accessory pathway:
35. The bundle of His receives its blood supply from ______________________ and ______________________ arteries.
36. Define His-Purkinje system:
37. The _____ bundle branch divides into _____ (#) fascicles, named:
38. Complete by naming leads and polarity ---------------------------
38. Explain the difference, in reference to polarity, with the augmented
leads (aVR, aVL, aVF):
39. Complete below for augmented lead polarity and name:
40. HMMMM…………………. -----------------------------------------------------
41. Complete the hexiaxial reference system diagram below, as it relates
to ECG axis determination (degrees go in the box, please write in the
corresponding lead):
42. Normal axis is ____degrees to ________ degrees.
43. Left axis deviation can indicate the presence of:
44. Right axis deviation can indicate:
45. Extreme (“no man’s land”) axis deviation may indicate:
46. Electricity flowing towards a positive polarity will have a _______________ waveform.
47. Electricity flowing away from a positive polarity will have a _______________ waveform.
48. Electricity flowing perpendicular positive polarity will have a _______________ waveform.
49. You need which ECG leads to determine axis deviation?
a.
b.
c.
d.
e.
f.
50. A right-sided 12-lead could be useful if ischemia is suspected in what location?
51. Explain proper lead placement for a right sided 12-lead ECG:
52. Lead I, aVL v5, and v6 provide view of what heart surface?
This also corresponds to which major coronary vessels?
53. Lead II, III, aVF provide view of what heart surface?
This also corresponds to which major coronary vessels?
54. Lead v1 and v2 provide view of what heart surface?
This also corresponds to which major coronary vessels?
55. Lead v3 and v4 provide view of what heart surface?
This also corresponds to which major coronary vessels?
56. If seen, normal Q waves are the first _______ deflection following the P wave, are less than ________ in duration,
and less than __________________________________ in amplitude.
How do you calculate QT interval?
What is a normal QT interval?
Prolonged QT (aka long QT syndrome) may indicate:
57. Describe a “U: wave and its location, if present in an ECG.
What does its presence indicate?
58. Describe a delta wave and its location, if present in an ECG.
What does its presence indicate?
59. Describe an Osborn wave and its location, if present in an ECG.
What does its presence indicate?
60. Describe an epsilon wave and its location, if present in an ECG.
What does its presence indicate?
61. Inverted T waves seen in V1 are normal for what patient population?
62. A pregnant patient may show ___________ axis deviation, which may be considered normal.
63. Neonate and young children may show _________ axis deviation, which may be considered normal.
64. What does “normal R wave progression mean”?
65. Abnormal R wave progression is often associated with what pathologies?
66. Internal pacemakers can produce what “normal” finding, that may be considered abnormal in a patient without a
pacemaker?
The following is from the new AHA 2013 guidelines for STEMI:





"New or presumed new" Left Bundle Branch Block is no longer an indication for a STEMI.
Providers should use Sgarbossa's criteria to diagnose STEMI in the presence of LBBB. (Editor's Note: we're
going to go ahead and add that our readers should take this one step further and utilize Smith's modification
to Sgarbossa's criteria.)
Isolated ST-depression in V1-V4 is an indication of a posterior STEMI.
Widespread ST-depression with ST-elevation in aVR is an indication of proximal LAD or LMCA occlusion.
(Editor's Note: the evidence points more towards this being an indication of 3-vessel disease or near occlusion
of the LAD/LMCA.)
Hyperacute T-waves, e.g. de Winter ST/T-wave changes, are an early indicator of a STEMI.
Full article available at: http://circ.ahajournals.org/content/early/2012/12/17/CIR.0b013e3182742cf6.citation
67. What is Sgarbossa’s criteria:
Sgarbossa’s criteria may be useful in determining STEMI with which two often difficult rhythms?
68. Explain concordant ST segment elevation:
69. Explain disconcordant ST segment elevation:
70. What is the criteria for “hyperacute” T waves?
71. What is Smith’s modification to Sgarbossa’s criteria?
72. What is Brugada’s syndrome?
73. What ECG findings may indicate Brugada’s?