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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 iis the tx for aortic regurg?
Decreased forward perfusion pulmonary congestion
Squat in response to cyanotic spell
Valve replacement once LV dysfx develops
Decrease preload -->lowers myocardial stress

2. What are the HACEK organisms? With what condition are they associated?
Right side - serotonin and other secretory products detoxified in the lung
Acute inflammation
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

3. What is the only Jones criteria that doesn't resolve with time?
Sudden cardiac death
Loeffler syndrome
Pancarditis
Coexisting mitral stenosis and fusion of commisures exist

4. What causes endocarditis of prosthetic valves?
Myocarditis
S epidermidis
Contraction band necrosis - reperfusion injury
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

5. What is the most common type of endocarditis?
Trisomy 21
Anterior wall of LV and anterior septum
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Infectious

6. What does granulation tissue contain?
Mid - systolic click followed by regurgitation murmur
Left -->right
Mitral regurg
Plump fibroblasts - collagen - blood vessels

7. How does adult coarctation of the aorta present?
Hypercoagulable state or underlying adenocarcinoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Shunt - PGE to maintain PDA until surgical repair can be performed
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

8. What are the complications of mitral stenosis?
Ventricles cannot pump
Thickening of chrodae tendinae and cusps - mitral stenosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
When a bacterial protein resembles a protein in human tissue

9. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Transesophageal echo
Minimizes ischemia
LHF
Red border granulation tissue

10. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Large - destructive vegetations
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
NG or Ca channel blocker

11. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Opening snap followed by diastolic rumble
Bounding pulse
Coexisting mitral stenosis and fusion of commisures exist

12. Which angina(s) show ST elevation on EKG? ST depression?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Metastasis
Prinzmetal stable and unstable
Holosystolic machine like murmur

13. What causes angina and syncope in aortic stenosis?

14. What is the murmur of mitral regurg?
Increased blood in right heart delays closure of P valve
Bicuspid aortic valve
R-->L
Holosystolic blowing murmur

15. Holosystolic blowing murmur that increases w/expiration?
Blood vessels coming in from normal tissue
Loss of fx
ST- segment depression
Mitral regurg

16. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Sudden cardiac death
Cardiac tamponade
Aortic regurg

17. What is the basic principle of CHF?
Congestive heart failure
Pump failure
Decrease in blood flow to an organ
ST- segment depression

18. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Positive blood cultures anemia of chronic disease
Sterile vegetations on mitral valve along lines of closure
S aureus

19. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Libman - Sacks endocarditis
PDA
Infectious endocarditis - arrythmias - severe mitral regurg no

20. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
4-24 hours
1-3 days out
Loss of LV fx

21. Which artery is most often occluded in an MI?
LAD
Degree of pulmonary artery stenosis
Intercostal arteries enlarged due to collateral circulation
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

22. Which vasculitis can cause MI?
Prophylactic abx during dental procedures
Kawasaki disease
Slow HR - decreasing O2 demand and risk for arrhythmia
Left -->right

23. What gross and microscopic changes occur 4-7 days after an MI?
Tetralogy of fallot
Dilated
Yellow pallor macrophages
Open blocked vessels

24. What are the clinical features of endocarditis? What causes each feature?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Degree of pulmonary artery stenosis
2-3%
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

25. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Friction rub and chest pain
Aortic regurg
Bacterial endocarditis

26. What does rupture of a papillary muscle cause?
1-3 days
Mitral insufficiency
Low voltage EKG w/diminished QRS amplitude
Right to left

27. What type of shunt does ASD cause?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Yellow pallor neutrophils
AD mutation in sarcomere proteins
Left -->right

28. What creates the immune reaction in acute rhuematic fever?

29. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Ischemic heart disease
Hypertrophic cardiomyopathy
Congestive heart failure

30. What are the clinical features of RHF due to?
Osler nodes (ouch - ouch Osler)
Increased blood in right heart delays closure of P valve
Systemic venous congestion
Annular - non pruritic rash w/erythematous borders trunks and limbs

31. What are the sx of pericardiits?
Hypertrophic cardiomyopathy
Friction rub and chest pain
1%
SLE

32. What is the murmur of mitral valve prolapse?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Reactive histiocyte with caterpillar nucleus
Mid - systolic click followed by regurgitation murmur
Sudden cardiac death

33. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Loss of LV fx
Stable and unstable prinzmetal
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Opening snap followed by diastolic rumble

34. What causes notching of the ribs in adult coarctation of the aorta?
Anterior wall of LV and anterior septum
Intercostal arteries enlarged due to collateral circulation
RBC damaged while crossing the calcified valve causing schistocytes
Membrane damage

35. What are Osler nodes?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Breast and lung carcinoma - melanoma - lymphoma
2-3%
Tender lesions on fingers or toes.

36. What is the most common cause of aortic stenosis?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
LAD
Wear and tear
Cardiac tamponade

37. What tests show prior group A beta - hemolytic strep infection?
Dilated
Elevated ASO anti - DNase B titers
Prinzmetal angina - cocaine
Wear and tear

38. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
2-3 weeks
Adult coarctation of the aorta
Right side - serotonin and other secretory products detoxified in the lung
LAD

39. What is typically the mechanims of sudden cardiac death?
RCA
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Ventricular arrhythmia
Atria and RV

40. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Mitral mitral+aortic
Endocarditis of prosthetic valves
IV drug users

41. What is the 1day-1wk -1mo mneumonic for MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Anitschow cell

42. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Volume overload and LHF
Preductal - post aortic arch
Friction rub and chest pain

43. What are the sx of PDA at birth?
Systolic ejection click followed by crescendo - decrescendo murmur
Indomethacin - decreases PGE
Asymptomatic
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

44. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Pulsating nail bed
AD mutation in sarcomere proteins
Wear and tear

45. What is the characteristic murmur of aortic stenosis?
Asymptomatic
Mitral mitral+aortic
Friction rub and chest pain
Systolic ejection click followed by crescendo - decrescendo murmur

46. What increases the risk for chronic rheumatic heart disease?
Large vegetations of S aureus
First 4 hours
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Aschoff bodies

47. What coronary artery supplies the mitral valve papillary muscles?
RCA
Prinzmetal stable and unstable
Mitral regurgitation due to vegetations
Dressler syndrome

48. What are Janeway lesions?
Posterior wall of LV - posterior septum - papillary muscles
LA dilation
PDA
Erythematous nontender lesions on palms and soles.

49. How does MI cause LHF?
When a bacterial protein resembles a protein in human tissue
Rupture of free wall - IV septum - or papillary muscle
Libman - Sacks endocarditis
Loss of LV fx

50. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S viridans
Indomethacin - decreases PGE
Cardiac tamponade