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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 gross and microscopic changes occur 4-7 days after an MI?
1-3 days out
Fetal alcohol syndrome
Yellow pallor macrophages
First 4 hours

2. Opening snap followed by diastolic rumble.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Bicuspid aortic valve
Mitral stenosis
Mitral mitral+aortic

3. What is the JOneS mneumonic?
Sudden cardiac death
Mitral regurg
Pump failure
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

4. When do CK- MB levels rise - peak - and return to normal?
Right to left
4-6 hours - 24 hours - 72 hours
Loeffler syndrome
Positive blood cultures anemia of chronic disease

5. What are the complications of aortic stenosis?
ASD - R-->L
Atherosclerosis of coronary arteries
Mitral regurgitation due to vegetations
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

6. What is the most common cause of endocarditis in IV drug users?
S aureus
Yellow pallor macrophages
PDA
ASD - R-->L

7. What is the only Jones criteria that doesn't resolve with time?
Coronary artery vasospasm
Pancarditis
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
Large - destructive vegetations

8. What effect does chronic rheumatic heart disease have on the aortic valve?

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9. What iis the tx for aortic regurg?
4-7 days
Valve replacement once LV dysfx develops
Stable angina
Stable and unstable prinzmetal

10. What is the tx for mitral valve prolapse?
S aureus
Coexisting mitral stenosis and fusion of commisures exist
Erythematous nontender lesions on palms and soles.
Valve replacement

11. What is the most common valve infected by S aureus?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Decrease preload -->lowers myocardial stress
Coxsackie A or B
Tricuspid

12. What does granulation tissue contain?
Blood vessels coming in from normal tissue
Ventricle
Plump fibroblasts - collagen - blood vessels
>70%

13. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Prinzmetal stable and unstable
Kawasaki disease
RCA
Congested central veins

14. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Libman - Sacks endocarditis
LHF
1%
Restrictive cardiomyopathy

15. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Libman - Sacks endocarditis
Myocardium
Systolic ejection click followed by crescendo - decrescendo murmur

16. What type of vegetations form in nonbacterial thrombotic endocarditis?
Decrease preload -->lowers myocardial stress
Ventricles cannot pump
1-3 days out
Sterile vegetations on mitral valve along lines of closure

17. What typically causes hypertrophic cardiomyopathy?
Prinzmetal
RBC damaged while crossing the calcified valve causing schistocytes
AD mutation in sarcomere proteins
Decrease preload -->lowers myocardial stress

18. What is Loeffler syndrome?
Pancarditis
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
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hypertophy of RV atrophy of LV

19. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Boot shaped heart
LHF
Infantile coarctation of the aorta
Prinzmetal angina

20. What is the cause of the red border around granulation tissue?
Circumflex
Yellow pallor neutrophils
Blood vessels coming in from normal tissue
LV dilation and eccentric hypertrophy

21. What does rupture of a papillary muscle cause?
Mitral insufficiency
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Right to left

22. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Stable angina
Months out fibrosis
LV dilation and eccentric hypertrophy
Holosystolic machine like murmur

23. What congenital heart defect is associated with fetal alcohol syndrome?
Valve replacement once LV dysfx develops
MI
VSD
Anitschow cell

24. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Anitschow cell
Nonbacterial thrombotic endocarditis (marantic endocarditis)
20 min
Shunt - PGE to maintain PDA until surgical repair can be performed

25. What are the sx of PDA at birth?
Asymptomatic
Myocarditis in acute rheumatic heart fever
Sterile vegetations on mitral valve along lines of closure
IV drug users

26. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Valve replacement once LV dysfx develops
Troponin I
Prophylactic abx during dental procedures

27. What are other (not atherosclerotic) causes of MI?
Membrane damage
Coronary artery vasospasm - emboli - vasculitis
Systolic ejection click followed by crescendo - decrescendo murmur
Contraction band necrosis - reperfusion injury

28. Which coronary artery supplies the anterior wall and anterior septum?
Plump fibroblasts - collagen - blood vessels
Hypertrophic cardiomyopathy
LAD
Stretched muscle loses contractility

29. What heart sound manifest with an ASD?
Prophylactic abx during dental procedures
Right -->left
Split S2 on auscultation
Valve replacement

30. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Mitral stenosis
PDA
Fibrosis and dystrophic calcification

31. What congenital heart defect presents later in life with lower extremity cyanosis?
Regurg vs stenosis
PDA
Nonspecific - eg fever and elevated ESR
Intercostal arteries enlarged due to collateral circulation

32. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Fetal alcohol syndrome
Loeffler syndrome
Systolic dysfx leading to biventricular CHF

33. What type of shunt does a VSD cause?
L->R
Ostium primum
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Stable and unstable prinzmetal

34. What is the most common cause of death during the acute phase of rheumatic fever?
MI
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Myocarditis

35. What coronary arterysupplies the lateral wall of the LV?
VSD
Within the first day
Concentric LV hypertophy
Circumflex

36. What is the effect of mitral regurg on the heart?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Aortic stenosis
Coronary artery vasospasm - emboli - vasculitis
Volume overload and LHF

37. What complication occurs 1-3 days post MI?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Fibrinous pericarditis
Louder - increased systemic resistence decreases LV emptying
Nonbacterial thrombotic endocarditis (marantic endocarditis)

38. What drugs can cause dilated cardiomyopathy?
Transesophageal echo
Doxorubicin - cocaine
Left -->right
Squat in response to cyanotic spell

39. With what developmental disorder is VSD associated?
White scar fibrosis
Hypertrophic cardiomyopathy
Fetal alcohol syndrome
Cyanosis - RV hypertrophy - polycythemia - clubbing

40. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Mitral regurgitation due to vegetations
S aureus
Holosystolic blowing murmur

41. What type of valvular vegetations does S aureus cause?
Libman - Sacks endocarditis
Large - destructive vegetations
Colon cancer
ST- segment depression

42. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
SLE
Myxoma - benign
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

43. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Split S2 on auscultation
Paradoxical emboli
Contraction band necrosis

44. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Minimizes ischemia
Sterile vegetations on surface and undersurface on mitral valve

45. What coronary artery supplies the mitral valve papillary muscles?
RCA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Large vegetations of S aureus
Stable angina

46. What is the classic EKG finding of restrictive cardiomyopathy?
Anterior wall of LV and anterior septum
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Valve replacement AFTER the onset of complications
Low voltage EKG w/diminished QRS amplitude

47. What causes prinzmetal angina?
Coronary artery vasospasm
LAD
Small vegetations along the line of closure
Months out fibrosis

48. What type of ASD is associated w/Down syndrome?
VSD
Pericarditits
Surgical closure small defects may close spontaneously
Ostium primum

49. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Blood vessels coming in from normal tissue
ST- segment elevation
Breast and lung carcinoma - melanoma - lymphoma

50. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Nitroglycerin
Loeffler syndrome
Congenital rubella