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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the most common cause of infectious endocarditis?
Blood vessels coming in from normal tissue
Sterile vegetations on mitral valve along lines of closure
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Streptococcus viridans

2. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Rupture of free wall - IV septum - or papillary muscle
Sudden cardiac death
>70%
RHF

3. What is the most comon cause of aortic regurg? What are the other causes?
Opening snap followed by diastolic rumble
Infectious endocarditis - arrythmias - severe mitral regurg no
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Hemosiderin laden macrophages

4. Large vegetations on tricuspid valve?
ASD - R-->L
Low voltage EKG w/diminished QRS amplitude
Indomethacin - decreases PGE
S aureus

5. What are the HACEK organisms? With what condition are they associated?
Sterile vegetations on mitral valve along lines of closure
CK- MB
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Subendocardial

6. Sudden death in a young athlete.
Congested central veins
Low voltage EKG w/diminished QRS amplitude
Hypertrophic cardiomyopathy
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

7. What is the most common cause of aortic stenosis?
Right to left
Nitroglycerin
Decrease in blood flow to an organ
Wear and tear

8. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Streptococcus viridans
Ostium primum
Cardiogenic shock - CHF - arrhythmia

9. What areas of the heart does the LAD supply?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Anterior wall of LV and anterior septum
CK- MB
Aneurysm - mural thrombus - Dressler syndrome

10. What are the complications that occur months after an MI?
Stable and unstable prinzmetal
Day 1-7
Aneurysm - mural thrombus - Dressler syndrome
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

11. What is molecular mimicry?
Ostium secundum (90%)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Holosystolic blowing murmur
When a bacterial protein resembles a protein in human tissue

12. In which chamber of the heart are rhabdomyomas found?
Mitral regurg
Contraction band necrosis - reperfusion injury
Ventricle
Mitral valve prolapse

13. When is an MI pt at greatest risk for cardiogenic shock?
Spontaneous
Ischemic heart disease
First 4 hours
Tetralogy of fallot

14. Which congenital heart defect is associated with maternal diabetes?
Bacterial endocarditis
Transposition of the great vessels
Turner syndrome
Intercostal arteries enlarged due to collateral circulation

15. What is the characteristic murmur of aortic stenosis?
Valve scarring that arises as a consequence of rheumatic fever
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Increased blood in right heart delays closure of P valve
Systolic ejection click followed by crescendo - decrescendo murmur

16. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
ACE inhibitor
Friction rub and chest pain
PDA

17. What gross and microscopic changes occur 1-3 weeks after an MI?
Preductal - post aortic arch
Red border granulation tissue
Chronic rheumatic heart disease
Backward LHF pulm htn and RHF - afib and associated mural thombis

18. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Regurg vs stenosis
Months out fibrosis
Adult coarctation of the aorta

19. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Mid - systolic click followed by regurgitation murmur
VSD
Libman - Sacks endocarditis

20. What conditions can cause nonbacterial thrombotic endocarditis?
Mid - systolic click followed by regurgitation murmur
Endocarditis of prosthetic valves
Mitral mitral+aortic
Hypercoagulable state or underlying adenocarcinoma

21. How does Eisenmeger syndrome occur?
Bicuspid aortic valve
Open blocked vessels
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

22. What type of shunt does truncus arteriosus cause?
CK- MB
Stable and unstable prinzmetal
R-->L
PDA

23. What does a biopsy of hypertrophic cardiomyopathy look like?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Large - destructive vegetations
RBC damaged while crossing the calcified valve causing schistocytes
Myofiber hypertrophy with disarray

24. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Spontaneous
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Louder - increased systemic resistence decreases LV emptying
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

25. Holosystolic blowing murmur that increases w/expiration?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Decreases LV dilation by decreasing volume
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral regurg

26. What causes endocarditis of prosthetic valves?
S epidermidis
Nonspecific - eg fever and elevated ESR
Tetralogy of fallot
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

27. How does subendocardial MI/ischemia present on EKG?
Aneurysm - mural thrombus - Dressler syndrome
Kawasaki disease
ST- segment depression
Decreases LV dilation by decreasing volume

28. What are the tx for MI?
Minimizes ischemia
Myofiber hypertrophy with disarray
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Valve replacement

29. What are the clinical features of LHF due to?
Atria and RV
Erythematous nontender lesions on palms and soles.
Dilated
Decreased forward perfusion pulmonary congestion

30. With what disease is Libman - Sacks endocarditis associated?
SLE
Yellow pallor macrophages
Endocardial fibroelastosis (rare)
Pump failure

31. What increases the volume of mitral regurg murmur?
LV dilation and eccentric hypertrophy
Aschoff bodies
Squatting - expiration
Chronic ischemic heart disease

32. What does rupture of the LV free wall cause?
Cardiac tamponade
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
Squatting - expiration
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

33. What are heart failure cells?
Adult coarctation of the aorta
Hemosiderin laden macrophages
2-3%
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

34. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
PGE
Pedunculated mass in the LA that causes syncope due to obstruction of MV
45%

35. What are the forward and backward sx of LHF?
Erythematous nontender lesions on palms and soles.
Loeffler syndrome
Osler nodes (ouch - ouch Osler)
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA

36. What is the most common cause of endocarditis in IV drug users?
Mitral insufficiency
White scar fibrosis
S aureus
PDA

37. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Day 1-7
Loss of LV fx
Chest pain <20 min brought on by exertion or emotional stress
LHF

38. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Chronic rheumatic heart disease
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Prophylactic abx during dental procedures

39. With what disease is infantile coarctation of the aorta associated?
Intercostal arteries enlarged due to collateral circulation
Maternal diabetes
Pump failure
Turner syndrome

40. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
3-8 wks
Myocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

41. What disesase has Aschoff bodies?
Pericarditits
Low voltage EKG w/diminished QRS amplitude
Myocarditis in acute rheumatic heart fever
Type I

42. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Yellow pallor macrophages
Mitral regurg

43. When does the heart have dark discoloration post MI?
Louder - increased systemic resistence decreases LV emptying
4-24 hours
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

44. What type of shunt does transposition of the great vessels cause?
Systolic ejection click followed by crescendo - decrescendo murmur
Dilation of all four chambers of the heart
RCA
R-->L

45. Which angina is relieved by Ca channel blockers?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Nitroglycerin
Prinzmetal
Yellow pallor neutrophils

46. What are the clinical features of RHF due to?
Nitroglycerin
Atherosclerosis of coronary arteries
First 4 hours
Systemic venous congestion

47. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Mitral valve prolapse
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Wear and tear

48. How do you tx prinzmetal angina?
NG or Ca channel blocker
2-3 weeks
Subendocardial
PDA

49. How does squating decrease hypoxemia in tetralogy of fallot?
Streptococcus bovis/
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rhadbomyoma - benign
Granulation tissue

50. With what congenital heart defect is ADULT coarctation of the aorta associated?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Bicuspid aortic valve
Squat in response to cyanotic spell
Prinzmetal stable and unstable