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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 complications occur 4-7 days post MI?
Bicuspid aortic valve
Regurg vs stenosis
Rupture of free wall - IV septum - or papillary muscle
Type I

2. What are the clinical features of RHF?
Squatting - expiration
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Volume overload and LHF
Boot shaped heart

3. What does chronic ischemic heart disease progress to?
Hypertrophic cardiomyopathy
Elevated ASO anti - DNase B titers
Ventricular arrhythmia
CHF

4. Dilated cardiomyopathy is a late complication of what illness?
Cardiac tamponade
Myocarditis
Months out fibrosis
Contraction band necrosis - reperfusion injury

5. What shunt does tetralogy of fallot produce?
Right -->left
Hypertrophic cardiomyopathy
Nitroglycerin
Coronary artery vasospasm

6. What coronary artery supplies the mitral valve papillary muscles?
R-->L
RCA
Tricuspid
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

7. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
2-3%
Restrictive cardiomyopathy
Valve replacement AFTER the onset of complications

8. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Pts w/previously damaged valves
20 min
Large - destructive vegetations
Kawasaki disease

9. What are the sx of hypertrophic cardiomyopathy?
Squatting - expiration
Prinzmetal stable and unstable
Small vegetations along the line of closure
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

10. What is the gold standard blood marker for MI?
Troponin I
MI
Dilated
IV drug users

11. What is the tx for LHF?
Mitral valve prolapse
ACE inhibitor
Aneurysm - mural thrombus - Dressler syndrome
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

12. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
1-3 days out
NG or Ca channel blocker
Day 1-7

13. What effect does dilated cardiomyopathy have on the heart?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Streptococcus viridans
Systolic dysfx leading to biventricular CHF
Within the first day

14. What is the tx for dilated cardiomyopathy?
Heart transplant
Opening snap followed by diastolic rumble
Myocardium
Large vegetations of S aureus

15. Opening snap followed by diastolic rumble.
Fibrinous pericarditis
Rupture of free wall - IV septum - or papillary muscle
Mitral stenosis
IV drug users

16. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Shunt - PGE to maintain PDA until surgical repair can be performed
Trisomy 21
Streptococcus bovis/

17. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Dressler syndrome
LAD
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

18. Are most congenital heart defects spontaneous or inherited?
ASD - R-->L
Large - destructive vegetations
Spontaneous
Pericardial effusion due to pericardial involvement

19. What is the rate of mitral valve prolapse in the US?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Breast and lung carcinoma - melanoma - lymphoma
2-3%
Backward LHF pulm htn and RHF - afib and associated mural thombis

20. How do you tx prinzmetal angina?
NG or Ca channel blocker
Coexisting mitral stenosis and fusion of commisures exist
Reperfusion injury
S epidermidis

21. What % stenosis causes stable angina?
PGE
Ventricle
Libman - Sacks endocarditis
>70%

22. What disesase has Aschoff bodies?
Tricuspid
Myocarditis in acute rheumatic heart fever
Hypertophy of RV atrophy of LV
Dark discoloration coagulative necrosis

23. How does reperfusion injury occur?
Coronary artery vasospasm
Dilated
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Friction rub and chest pain

24. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Atria and RV
Intercostal arteries enlarged due to collateral circulation
Degree of pulmonary artery stenosis
Coronary artery vasospasm

25. What is an important complication of ASD?
Decreases LV dilation by decreasing volume
Paradoxical emboli
PDA
Hypercoagulable state or underlying adenocarcinoma

26. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Friction rub and chest pain
Endocarditis of prosthetic valves
Systolic ejection click followed by crescendo - decrescendo murmur

27. What are the clinical features of endocarditis? What causes each feature?
Large vegetations of S aureus
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
R-->L
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

28. What is dilated cardiomyopathy?
Large vegetations of S aureus
Dilation of all four chambers of the heart
Aortic regurg
1-3 days out

29. How does transmural MI/ischemia present on EKG?
Atria and RV
ST- segment elevation
Janeway lesions
Preductal - post aortic arch

30. What are the sx of right - to - left shunt?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Cyanosis - RV hypertrophy - polycythemia - clubbing
Sterile vegetations on surface and undersurface on mitral valve
Metastasis

31. What murmur ccan be heard in PDA?
Boot shaped heart
Rupture of free wall - IV septum - or papillary muscle
Friction rub and chest pain
Holosystolic machine like murmur

32. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Inability to maintain systemic pressure w/lack of O2 to vital organs
RBC damaged while crossing the calcified valve causing schistocytes
Dense layer of elastic and fibrotic tissue in the endocardium - children

33. What is the foundation of a scar?
Granulation tissue
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nitroglycerin
Split S2 on auscultation

34. What are the sx of pericardiits?
Mitral mitral+aortic
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Friction rub and chest pain

35. Which congenital heart defect is associated with congenital rubella?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Holosystolic blowing murmur
PDA
Hypercoagulable state or underlying adenocarcinoma

36. What type of shunt does truncus arteriosus cause?
R-->L
Myocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Adult coarctation of the aorta

37. How does aortic regurg affect the heart chambers?
Fibrosis and dystrophic calcification
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Gelatinous - abundant ground substance
LV dilation and eccentric hypertrophy

38. What are the forward and backward sx of LHF?
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
Mitral mitral+aortic
Atherosclerosis of coronary arteries
Preductal - post aortic arch

39. Is injury due angina reversible or irreversible?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Reversible
Gelatinous - abundant ground substance
Doxorubicin - cocaine

40. What are the Jones criteria?
Right to left
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
RBC damaged while crossing the calcified valve causing schistocytes
Holosystolic machine like murmur

41. What effect does mitral stenosis have on the heart chambers?
Libman - Sacks endocarditis
Prinzmetal
Troponin I
LA dilation

42. How does restrictive cardiomyopathy cause LHF?

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43. What congenital heart defect presents later in life with lower extremity cyanosis?
Transposition of the great vessels
PDA
Nonspecific - eg fever and elevated ESR
Circumflex

44. Which angina(s) show ST elevation on EKG? ST depression?
Low voltage EKG w/diminished QRS amplitude
Prinzmetal stable and unstable
Turner syndrome
Transposition of the great vessels

45. With what condition are rhabdomyomas associated?
Degree of pulmonary artery stenosis
Troponin I
Tuberous sclerosis
Congested central veins

46. What is typically the mechanims of sudden cardiac death?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Ventricular arrhythmia
Infectious endocarditis
Cyanosis - RV hypertrophy - polycythemia - clubbing

47. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Adult coarctation of the aorta
Dilated
Stretched muscle loses contractility

48. What causes notching of the ribs in adult coarctation of the aorta?
PGE
Sterile vegetations on mitral valve along lines of closure
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Intercostal arteries enlarged due to collateral circulation

49. What type of valvular vegetations does S aureus cause?
Mitral regurg
S aureus
Spontaneous
Large - destructive vegetations

50. What increases the volume of mitral regurg murmur?
Reactive histiocyte with caterpillar nucleus
Squatting - expiration
Turner syndrome
Reperfusion injury