NURS 617 EXAM 5 NEWEST 2025 ACTUAL EXAM STUDYGUIDE QUESTIONS AND DETAILED CORRECT ANSWERS, Exams of Nursing

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NURS 617 EXAM 5 NEWEST 2025 ACTUAL EXAM STUDYGUIDE QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE STUDYGUIDE 2024-2025 aortic stenosis Correct Answer -either d/t genetics or calcification of aortic valve cusps that increases resistance of ejection of blood from LV to aorta -causes measurable decrease in CO; eventually leads to HF -differs from aortic sclerosis d/t flow not being obstructed in sclerosis like it is in stenosis -s/s: loud systolic murmor or split s2 -tx: valve replacement, cholesterol rx, anti-HTN rx aortic regurgitation Correct Answer -(aortic insufficiency) incompetent aortic valve that allows backward flow of blood into left ventricle during diastole -makes L ventricle increase stroke volume to include blood entering from lungs and blood leaking from aortic valve -results in pulmonary edema and L side HF -tx: valve replacement fetal heart development + circulation (fetal + perinatal) Correct Answer -heart develops between 4-7 weeks of gestation; first functioning organ in embryo -fetal=o2 through placenta; fetal cardiac output +HR=higher d/t lower spo2 -perinatal=o2 in lungs heart disease in pediatrics: prophylactic measures Correct Answer -prophylactic abx before dental procedures d/t risk of IE and RF patent ductus arteriosus (PDA) Correct Answer -common in kids; an abnormal opening between the pulmonary artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth -failure to divert blood from R side of heart away from lungs; leads to pulmonary HTN and congestion -s/s: machine like murmor continuous through systole + diastole, widened pulse pressure -if untreated=results in congestive HF, IE, calcification, thrombus formation, aneurysm formation arterial septal defect Correct Answer -Increased pulmonary blood flow, risk for pulmonary vascular disease; increase in blood volume that must be ejected from R side; prolongs closure of pulmonary valve and produces separation of aortic + pulmonary components -there is a hole between the atria; oxygenated blood from the left atrium is shunted to the right atrium and lungs -do not compromise children seriously; surgical closure is recommended before school age; can lead to congestive heart failure or atrial dysrhythmias later in life if not corrected Shock lung, acute lung injury, or adult respiratory distress syndrome Hepatic failure Paralytic ileus, stress or hemorrhagic ulcers Multi-organ dysfunction syndrome Infection or septicemia Disseminated intravascular coagulation Depression of cardiac function cardiac action potential: 5 steps Correct Answer -phase 0: QRS complex; rapid uptake of action potential; rapid influx of Na+ into cell, causes cardiac cell to change from - to + -phase 1: early polarization; inactivation of Na+ channels -phase 2: plateau (ST segment); K+ permeability is low, calcium slowly infiltrates -phase 3: final repolarization period (T wave); rapid repolarization; sharp influx of K+ -phase 4: diastolic repolarization period; Na+ out, K+ in until resting membrane potential is reached (-60 to - 90mV); during diastole AND REPEAT cardiac conduction system Correct Answer 1. SA node (atrial conduction; pacemaker of the heart, fastest rate of firing) 2. AV node & bundle of his(connection between atria and ventricles; blocked=atria and ventricles beat separately; slower conduction) 3. purkinje system (ventricular conduction; rapid conduction; can assume pacemaker function if AV node conduction cannot pass) absolute vs relative refractory period Correct Answer Absolute: membrane cannot be stimulated to produce action potential (prevents dysrhythmias); Na+ inactivation gate closes, activation gate still open Relative: membrane potential below threshold; Na+ inactivation gate reopens and activation gate closes [de- inactivation] - ready to participate in AP again supernormal excitatory period Correct Answer A weak stimulus can evoke depolarization Extends from the terminal portion of phase 3 until the beginning of phase 4 Cardiac arrhythmias develop EKG: what each segment represents Correct Answer P: SA node P-Q: delay in AV node tranmission QRS: ventricular contraction/purkinje S-T: repolarization of ventricles -EKG detects early ischemia and prevents early MI complications -improper lead placement can change QRS mechanisms of arrhythmias and conduction dx Correct Answer 1. automaticity: specific cells spontaneously initiating an impulse 2. excitability: cells ability to respond to an impulse 3. conductivity: cells ability to conduct impulses 4. refractoriness: extent of cells to respond to stimulus *cardiac scar tissue slowens conduction, increases chance of unilateral block & arrythmias respiratory sinus arrythmia Correct Answer -normal P, QRS and T waves but the heart rate varies with respiration - the rate increases on inspiration and decreases on expiration -more common in kids sinus bradycardia Correct Answer <60 normal sinus rhythm, origin=SA node can be d/t rx, athletes Sinus Tachycardia Correct Answer >100 bpm normal sinus rhythm, origin=SA node can be d/t fever, blood loss, anxiety, exercise, SNS stimulation, loss of vagal tone supraventricular vs ventricular arrythmias Correct Answer -supraventricular=dx of atrial rhythm or conduction above the ventricles (ex: afib, a flutter, PAC) -ventricular=dx of ventricular rhythm or conduction; can be life threatening (ex: vtach, vfib) premature arterial contraction (PAC) Correct Answer - arrhythmia in which atria contract earlier than they should; SA node does not reach AV -additional P wave PNS vs SNS impact on respiratory system Correct Answer PNS=airway constriction, increase in secretions SNS=airway dilation, decrease in secretions structure of lung Correct Answer - trachea - splits into 2 bronchi - one to each lung - bronchi split into smaller tubes - bronchioles - bronchioles end in alveoli where gas exchange occurs - R lung=3 lobes, L lung=2 lobes - mediastinum holds lungs in place conducting airways Correct Answer -nasal cavity, oral cavity, pharynx, larynx, trachea, right and left pulmonary bronchi, bronchioles -"conditions" inspired air; warms, filters, and moisturizes air as it passes through; mucous membranes moistened, blood flow warms, and mucociliary blanket removes foreign materials -impairment of mucociliary blanket=increased debris in lungs; causes=tobacco, dust; results in chronic bronchitis, emphysema fever: effect on resp system Correct Answer -increase in water vapor=loss of water from mucosa=thicker mucous -^ why you need to increase h2o intake when sick nasopharyngeal Correct Answer -pertaining to nose and throat -help protect against obstruction larynx Correct Answer voice box; passageway for air moving from pharynx to trachea; contains vocal cords tracheobronchial tree Correct Answer branching structures of the respiratory system that resemble an upside-down tree trunk and its branches; includes trachea, bronchi, and bronchioles. function of lungs vs lobules vs alveoli Correct Answer - lungs: gas exchange, inactive vasoactive substances (bradykinin), convert angiotensin I to II. reservoir for blood storage. -lobules: gas exchange -alveoli: terminal air space for resp tract; gas exchange between air and blood. contains brush cells (monitor air quality of lungs) and macrophages (remove debris from lungs) alveoli: type I vs II pneumocytes Correct Answer I: 95% of cells; create barrier between air and alveoli wall, cannot divide II: 5%; synthesize surfacant, which decreases surface tension of alveoli to aid in expansion/inflation; starts maturing at 26-27 weeks, betamethasone used for pre- term babies to prevent ARDs pulmonary vs bronchial circulation Correct Answer Pulmonary Circulation=deoxygenated blood that flows from the right ventricle to the alveoli to be oxygenated. It returns to the heart via the pulmonary vein. Bronchial Circulation=oxygenated blood that flows from the left ventricle (via the thoracic aorta) to supply the tissues of the lungs and tracheobronchial tree; some of the now-deoxygenated blood returns to the heart via the pulmonary vein, some by the bronchial veins, and some by the bronchopulmonary veins. -can undergo angiogenesis (formation of new vessels) lymphatic circulation: resp system Correct Answer - superficial vessels: drains surface of the lungs, travels through connective tissue of visceral pleura -deep lymphatic vessels: drains the pulmonary artery/veins, bronchial tree through bronchioles **aids in removal of particulates/plasma proteins to prevent excess fluid in the pleural cavity pleura of the lungs Correct Answer -serous membrane that lines the lungs; outer surface adheres to thoracic wall, inner adheres to lungs -serous fluid between the 2 layers help protect the pleura -inflammation of pleura = pleural effusion; produces machine-like sound **pleura=only part of lung w/ pain receptor lung volumes Correct Answer -tidal volume=500ml -inspiratory reserve volume=air inspired in excess of the tidal volume -expiratory reserve volume=volume of air expired in excess of tidal volume -residual volume=volume of air remaining in lungs after max expiration what part of brain controls breathing Correct Answer - medulla oblongata in brain stem (aka pacemaker) -chemoreceptors monitor blood levels of o2, co2, & pH -lung receptors monitor breathing patterns and lung function -coughing=reflex to protect lungs from secretions & debris dyspnea + causes Correct Answer -sensation/perception of difficulty breathing -primary lung disease=asthma, pneumonia, emphysema -heart disease/pulmonary congestion (L side HF) -exercise induced, anxiety upper vs lower respiratory tract Correct Answer Upper: Nasal cavity, pharynx and larynx Lower: trachea, primary bronchi and lungs -most common cause of infections=viruses pneumonia: bacterial + viral Correct Answer -bacterial infection + inflammation of lung tissue; alveoli in the affected areas fill w/fluid, impacts part or all of a lobe -hospital or community acquired -can also be viral (aka walking pneuomina); lack of alveolar exudate pneuomococcal pneumonia Correct Answer -acute bacterial pneumonia=most common; involves strep pneumoniae (gram +) -s/s: sudden onset, fever, severe ineffective thermoregulation, pleuretic pain w/ movement, blood- tinged sputum, audible fine crackles -prevent w/ vaccine in those 60+y/o pneuomococcal pneuomia: pathogenesis Correct Answer - congestion (24h): protein rich fluid w/ organism fills alveoli -red hepatizations (2 or more days): increase in WBC/RBC, alveoli not able to move gases well; RBC bursting=pink or red mucous -grey hepatization (2-3 days after red, up to 8 days): macrophages phagocytose debris and produce grey appearance; congestion improves -resolution: immune cells worked against infection, fibrous growths dissolve (gas exchange improves), alveoli function recover tuberculosis Correct Answer -Mycobacterium tuberculosis - enters lungs via air, triggers cell-mediated hypersensitivity response -lytic enzymes released in lung and causes damage; result in ghon complex (lung lesion) -healed dormant lesion=latent TB; can be reactivated -s/s: fatigue, fever, weight loss, night sweats, chest pain, dry cough, anemia, dyspnea small cell lung cancer Correct Answer -20-25% of lung cancers;rapidly growing tumor in bronchioles that tends to metastasize quickly, oftenly to brain -strong association w/ tobacco -causes neoplastic syndrome - tumor secretions (hormones, cytokines, TNF, Interleukin-1), may cause hypercalcermia, hypoglycemia, SIADH non-small cell lung cancer Correct Answer -Squamous cell carcinoma (25-40%); common in men and smokers; originates in central bronchi, spreads centrally; causes neoplastic syndrome -Adenocarcinoma (20-40%): common in women and nonsmokers; originates in bronchiolar or alveolar tissue -Large cell carcinoma (10-15%): metastasizes early, originates in outer edge of lung, invades bronchi and large airways s/s of lung cancer Correct Answer -dry hacking cough -hoarseness -dyspnea -hemoptysis/rust colored sputum -pain in chest area -diminished breath sounds/wheezing -pleural effusion -common areas of metastasis: brain, liver, bone RDS in infants Correct Answer -most common in pre terms born gestation < 34 weeks -s/s: nasal flaring, grunting, tachypnea, accessory muscle use -betamethasone (surfacant) used in infants up to 36 weeks of gestation Pneuomothorax Correct Answer -Accumulation of air in the pleural space, also known as collapsed lungs. -can be spontaneous (d/t rupture), traumatic (d/t penetrating or nonpenetrating wound), tension (intrapleural pressure exceeds atmosphere, air cannot enter or leave; LIFE THREATENING) asthma Correct Answer -A chronic allergic/inflammatory disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing -genetic predisposition - IgE hypersensitivity response -causes airway inflammation, bronchospasm, mucus production, epithelial damage -T cells, eosinophils, cytokines, neutrophils, and macrophages activated types of asthma: mild vs severe vs progressive Correct Answer mild=slight wheeze, chest tightness, prolonged expiration, slight increase in HR more severe=accessory muscle use, decreased breath sounds, air trapping, loud wheeze progressive=diaphoretic/anxious/worsening SOB/airflow very reduced, breath sounds inaudible..diminished wheeze=ominous sign of resp failure COPD Correct Answer -chronic obstructive pulmonary disease- progressive, chronic/recurrent airflow obstruction/air trapping/decreased gas exchange -manifestations: loss of lung elasticity (proteases break down elastin), loss of alveolar tissue (proteases break down alveolar walls), hypertrophy of mucosal glands (increased mucous production), fibrosis, inflammation -common in smokers, alpha-1 antitrypsin deficiency Emphysema Correct Answer -a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness -2 types: centrilobular (smokers; upper lobes and superior lower lobes) and panlobular (ATT deficiency; early- peripheral alveoli, later=central bronchioles) chronic bronchitis Correct Answer -inflammation of bronchi persisting over a long time causes hypertrophy + hypersecretion of mucus/inflammation/fibrosis; type of chronic obstructive pulmonary disease (COPD) -airway obstruction of major and small airways -most common causes=recurrent infections and smoking chronic interstitial (restrictive) lung disease Correct Answer -group of lung disorders producing inflammatory and fibrotic changes; effect collagen/elastic connective tissues of alveolar walls, which causes decreased lung volume/hypoxemia/decreased diffusion -insidious; 1st sign=SOB w/ exercise, nonproductive cough, wheezing, hypoxemia @ rest, hypercapnia/resp acidosis -examples: pulmonary fibrosis, interstitial pneumonia, asbestosis, sarcoidosis Acute lung injury (ALI)/Acute respiratory distress syndrome (ARDS) Correct Answer -rapid onset within 12- 18h after event (infection, trauma, chronic lung disease or neuromuscular disease) -respiratory system fails gas exchange and/or ventilation -local and systemic inflammatory response; causes widespread endothelial injury, increases permeability of alveolar membrane and becomes filled with fluid...lungs become stiff and difficult to inflate -results in hypoxemia, hypercapnia, respiratory acidosis acute respiratory failure: ventilation vs perfusion/vent mismatching Correct Answer ventilation=normal perfusion w/ inadequate ventilation d/t insufficient o2 to aveoli and retained co2; d/t upper airway obstructions, chest wall injury, or weakness/paralysis of respiratory muscles perfusion/ventilation mismatching=adequate ventilation w/ inadequate perfusion OR perfused but not ventilated; hypoxemic failure; d/t advanced COPD, severe pneumonia, or atelectasis cystic fibrosis Correct Answer -two copies of recessive allele (transmembrane conductance regulator (CFTR) gene) -characterized by an excessive secretion of mucus and consequent vulnerability to infection; fatal if untreated -GI manifestations (fatty stool) right ventricular hypertrophy with cor pulmonale Correct Answer -causes pulmonary HTN, results in hypertrophy of R ventricle and eventually R side HF -severe fluid build up in lungs can lead to shock acute arterial occlusion Correct Answer -sudden blockage of an artery, typically in the lower extremity (tibial, pedal, peroneal), in the patient with chronic peripheral arterial disease -50% narrowing of artery until s/s appear -s/s: intermittent claudication (pain w/ walking that resolves w/ rest), pallor, shiny skin w/o hair, weak pedal pulse, cool to touch, sores that wont heal -dx: lower systolic BP in ankle than brachial, doppler ultrasound -tx: aspirin, plavix; NO NICOTINE OF ANY KIND thrombroangitis obliterans/burger disease Correct Answer -inflammatory arterial disorder that causes thrombus formation; effects medium sized arteries (femoral, digital, plantar) -s/s: pain distal to arterial ischemia, intermittent claudication in arch of foot + digits, malformed nails -extremities can turn gangrene & require amputation **NO NICOTINE; TRIGGERS INFLAMMATORY RESPONSE raynaud disease vs phenomenon + tx Correct Answer - intense vasospasm of arteries + arterioles in fingers, sometimes toes; ischemia causes pallor/cyanosis -disease=precipitated by cold or extreme emotions; not a secondary disorder, seldom causes tissue necrosis -phenomenon= can cause tissue necrosis; d/t previous tissue trauma (ex: frost bite, heavy vibratory tools, lupus/collagen dx) -tx: vasodilators; minipress, calcium channel blockers (nifidepine, diltiazem) aneurysms: true vs false Correct Answer true= bounded by a complete vessel wall; blood remains within vascular compartment false=local dissection or tear in inner wall of artery; forms extravascular hematoma and causes vascular enlargement; only bound by outer layers of vessel wall or supporting tissues aneurysms: berry vs fusiform Correct Answer - berry=small, spherical vessel dilation; usually in circle of willis -fusiform=gradual enlargement of aorta; usually abdominal or thoracic aneurysms: causes Correct Answer -abnormal dilation of blood vessel; can be in artery or vein -causes=trauma, infection, atherosclerosis aortic aneurysms Correct Answer -weakness in the wall of the aorta that makes it susceptible to rupture -involves any part of aorta; ascending, descending, and abdominal -abdominal=most common -usually asymptomatic; pulsing mass d/t calcification over time -risk factors: HTN, atherosclerosis, male, smoker, 50+ aortic dissection Correct Answer -acute, life threatening hemmorhage into blood vessel wall w/ long tearing of vessel wall to form blood-filled channel -causes: HTN, pregnancy, connective tissue disease (marfans) -s/s: abrupt excrutiating pain, syncope, pulse unattainable in one or both arms, paralysis of lower extremities -occurs w/o evidence of previous vessel dilation; usually thoracic or ascending aorta factors in developing venous dx Correct Answer 1. level of activity in lower extremities - skeletal muscle contraction moves blood back to heart 2. # of valves in veins to prevent retrograde of blood - less=genetic predisposition to varicose veins 3. changes in thoracic pressure when breathing - increase in pressure (ex-HTN)=increase risk of varicose veins varicose veins Correct Answer -abnormally swollen, twisted veins with defective valves; most often seen in the legs -most common cause=DVT -other causes: increase in abdominal pressure (HTN, obesity), prolonged standing w/o use of leg muscles to pump blood back to the heart -tx: compression stockings, calf pumps chronic venous insufficiency Correct Answer -venous circulation is inadequate due to partial vein blockage or leakage of venous valves (or both); muscle pumps ineffective cardiac ouput Correct Answer -the volume of blood pumped by one ventricle per minute, average is 5Lin a normal resting adult -stroke volume x HR ejection fraction Correct Answer -measurement of the volume percentage of left ventricular contents ejected with each contraction -SV/end-diastolic volume X 100 -normal=55-75% -55%>=heart failure arteries vs veins Correct Answer -arteries: carry blood away from heart; thick, elastic walls; have highest pressure, provide resistance to circulatory flow -veins: carry blood to heart; low pressure, thin walls to collect blood from capillaries (acts as reservoir to return blood to R side of heart); contains largest amount of blood blood flow: normal vs abnormal Correct Answer blood flow=laminar vessels, one directional flow abnormal=turbulent; causes whirlpool or backflow of blood, causes murmor/bruit upon auscultation **closed end system R vs L side of heart Correct Answer R=pulmonary L=systemic -output of both must be the same; if R pumps less, blood accumulates in systemic circulation...if L pumps less, blood accumulates in lungs 3 factors governing blood flow Correct Answer pressure, resistance, flow -increase in viscosity and decrease in temp=decrease in blood flow compliance Correct Answer -total quantity of blood that can be stored in a given portion of circulation for each mm HG increase in pressure -compliance=increase in volume/increase in pressure; ability to increase of decrease depending on BP -most distended=veins pre load vs after load vs inotropy Correct Answer -pre- load: ventricular filling/end-diastolic pressure; volume of blood prior to systole, largely determined by venous return to heart -after-load: resistance of ejection of blood from the heart; pressure muscles are exerted to move blood into aorta and around body; aortic stenosis can increase afterload -inotropy: force of cardiac contractility; increase in inotropy=increase in ejection fraction + SV Heart Sounds S1 S2 S3 S4 Correct Answer S1 - normal; lub, produced by closure of the mitral valve S2 - norma; dub, produced by closure of the aortic valve S3 - abnormal; early diastole, occurs after the mitral valve opens; rapid ventricular fillingsyss S4 - abnormal; late diastole, occurs during atrial contraction **S3 + S4=indicative of resistance of ventricular filling law of laplace Correct Answer -pressure is directly proportional to surface tension and inversely proportional to radius of alveolus -wall tension increases as wall becomes thinner, wall tension decreases as wall becomes thicker Frank-Starling Mechanism Correct Answer -A mechanism by which the stroke volume of the heart is increased by increasing the venous return of the heart (thus stretching the ventricular muscle). -allows heart to adjust pumping ability to accommodate venous return -increase in force of contract=increase in ventricular end diastolic volume Pulmonary vs. Systemic Circulation: pressure/resistance Correct Answer pulmonary=low pressure, low resistance; avg 90mm Hg; right side of heart systemic=high pressure, high resistance; avg 12mm Hg; left side of heart Blood flow through the heart Correct Answer 1-Superior & Inferior Vena Cava, 2-Rt Atrium, 3-Tricuspid Valve, 4- Rt Ventricle, 5-Pulmonary Valve, 6-Pulmonary Artery, 7- stable vs unstable plaque Correct Answer Unstable plaque - white/grey, platelet rich; large lipid core with a thin fibrous cap made of smooth muslce -- can easily rupture Stable plaque - red; small lipid core with a thick fibrous cap made of smooth muscle -- doesn't easily rupture pericarditis Correct Answer -inflammation of the sac surrounding the heart; associated w/ increased capillary permeability -can be acute (<2 weeks); d/t viral or bacterial infx, reoccurring=d/t autoimmune dx -fibrous exudate deposes scar tissue on pericardium; can lead to adhesions/thrombosis -causes increase in fluid and pain d/t fluid friction (high pitch/scratchy on systole), decreased CO -s/s: chest pain relieved by leaning forward, pericardial friction rub, increased ESR & CRP tx: NSAIDs, abx, corticosteroids, colchicine Pericardial Effusion and Cardiac Tamponade Correct Answer -accumulation of fluid in the pericardial cavity -extensive pericardial effusion leads to cardiac tamponade; excess fluid in the pericardial cavity limit the expansion of the heart during cardiac filling -s/s: pulsus paradoxus (weak pulse during inspiration, strong during exhalation; compressed L ventricle=less output & ventricle filling), cushing's triad (tachy, narrowed pulse pressure, jugular vein distention), shock -tx: pericardiocentesis, NSAIDs, corticosteroids, colchicine constrictive pericarditis Correct Answer -causes: tuberculosis (developing world); systemic lupus erythematosus (developed world) -calcified scar tissue develops on pericardium, causes decrease in diastolic filling; causes equalization of end- diastolic pressures in all 4 chambers (R side filling pressures normally lower than L side) -s/s: ascites, jugular vein distention, weight loss, muscle wasting, pedal edema, dyspnea on exertion -tx: pericardiectomy coronary artery disease (CAD) Correct Answer -a condition affecting arteries of the heart that reduces the flow of blood and the delivery of oxygen and nutrients to the myocardium; most often caused by atherosclerosis -development is usually slow, progressive -dx: exercise stress test (CAD=chest pain, SOB, ST- segment changes, decrease in BP), echo, EKG, arteriography, cardiac cath stable vs unstable angina Correct Answer stable - a pattern of symptoms that has unchanged for 6 or more weeks; more during stress/exercise unstable - a pattern of symptoms that is new in onset, changing in severity or frequency, occurring at rest, or lasting longer than 20 minutes. 3 factors controlling coronary circulation Correct Answer HR, L ventricular contractility, systolic pressure -HR=most important; increase HR=increase O2 consumption, decreased diastolic filling time -regulated by O2 needs vasodilator drugs Correct Answer 1. adenosine 2. nitric oxide 3. dopamine/dobutamine - increases myocardial contractility and SV acute coronary syndrome (ACS) Correct Answer -sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction d/t unstable atherosclerotic plaques -s/s: increased troponin I/T/creatine kinase, abnormal Q wave/T wave inversion/ST segment elevation, angina at rest >20min ST-segment elevation MI: s/s + tx Correct Answer - ischemic death of myocardial tissues; usually abrupt, or chronic is progressed from unstable angina/NSTEMI -s/s: substernal pain that radiates to L arm/neck/jaw, N/V, frothy pink mucous...eventually leads to shock d/t low CO -death d/t MI happens within 1h of s/s onset d/t arrythmias -results in scar tissue & decreased ability to contract heart -tx: thrombolytic agent within 60-90min, nitro, o2, nitrates, aspirin, pain (morphine), beta-blockers, reperfusion therapy (re-establish blood flow to heart to prevent necrosis, eg: CABG), fibrinolytic therapy (TPA) to dissolve unstable plaques