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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 RHF? What are others?
Right side - serotonin and other secretory products detoxified in the lung
Reperfusion injury
Coronary artery vasospasm
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

2. What are the sx of cardiac myxoma?
Loss of LV fx
Stretched muscle loses contractility
Heart can't fill
Pedunculated mass in the LA that causes syncope due to obstruction of MV

3. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
>70%
Transposition of the great vessels

4. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
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
Ventricles cannot pump
Small - nondestructive vegetations (subacute endocarditis)

5. What are the laboratory findings of bacterial endocarditis?
PDA
Positive blood cultures anemia of chronic disease
Group A beta - hemolytic streptococci
Decreased forward perfusion pulmonary congestion

6. What causes angina and syncope in aortic stenosis?

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7. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
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
Decrease preload -->lowers myocardial stress
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

8. What effect does dilated cardiomyopathy have on the heart?
Sterile vegetations on mitral valve along lines of closure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Systolic dysfx leading to biventricular CHF
Squatting - expiration

9. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Loeffler syndrome
Papillary muscle - free wall - IV septum
Endocardial fibroelastosis (rare)

10. What are heart failure cells?
Mitral regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hemosiderin laden macrophages
Trisomy 21

11. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Myxoid degeneration
Tuberous sclerosis
Aortic regurg
Osler nodes (ouch - ouch Osler)

12. What causes acute endocarditis?
RBC damaged while crossing the calcified valve causing schistocytes
Large vegetations of S aureus
R-->L
Troponin I

13. What is the most common cause of endocarditis in IV drug users?
S aureus
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral insufficiency
LAD

14. What is the rate of congenital heart defects?
Wear and tear
Yellow pallor neutrophils
1%
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

15. What type of collagen is involved in fibrosis?
Sudden cardiac death
Within the first day
AD mutation in sarcomere proteins
Type I

16. What is the most common tumor of the heart?
Metastasis
IV drug users
Mitral valve prolapse
Reperfusion injury

17. How does restrictive cardiomyopathy present?
Congestive heart failure
Migratory polyarthritis
Boot shaped heart
Dressler syndrome

18. What is endocardial fibroelastosis? In what population is it found?
S epidermidis
Tricuspid
Congestive heart failure
Dense layer of elastic and fibrotic tissue in the endocardium - children

19. How does hypertension cause LHF?

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20. What is the 1day-1wk -1mo mneumonic for MI?
Concentric LV hypertophy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Slow HR - decreasing O2 demand and risk for arrhythmia
Endocardial fibroelastosis

21. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Tender lesions on fingers or toes.
Colon cancer
Opening snap followed by diastolic rumble

22. What coronary arterysupplies the lateral wall of the LV?
1-3 days out
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Circumflex
Infectious endocarditis - arrythmias - severe mitral regurg no

23. Which coronary artery supplies the anterior wall and anterior septum?
Colon cancer
Yellow pallor macrophages
LAD
Concentric LV hypertophy

24. What are the sx of PDA at birth?
Nitroglycerin
Limits thrombosis
Friction rub and chest pain
Asymptomatic

25. What heart sound manifest with an ASD?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
R-->L
Split S2 on auscultation
Bounding pulse

26. What type of shunt does a VSD cause?
>70%
L->R
First 4 hours
Loss of fx

27. What causes the split S2 in ASD?
VSD
Increased blood in right heart delays closure of P valve
Congenital rubella
Coexisting mitral stenosis and fusion of commisures exist

28. Vegetations on surface and undersurface of mitral valve.
Within the first day
Libman - Sacks endocarditis
Months out fibrosis
Eisenmenger syndrome

29. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Libman - Sacks endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

30. How do ACE inhibitors tx MI?
Trisomy 21
4-7 days
Chronic rheumatic heart disease
Decreases LV dilation by decreasing volume

31. What are the causes of restrictive cardiomyopathy in adults?
RCA
Tender lesions on fingers or toes.
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

32. What is the murmur of mitral valve prolapse?
Loss of fx
Left -->right
Mid - systolic click followed by regurgitation murmur
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

33. What is the cause of restrictive cardiomyopathy in children?
Janeway lesions
Limits thrombosis
Anterior wall of LV and anterior septum
Endocardial fibroelastosis (rare)

34. What is the JOneS mneumonic?
Friction rub and chest pain
IV drug users
Loss of LV fx
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

35. Which congenital heart defect is associated with maternal diabetes?
Migratory polyarthritis
Ventricle
Transposition of the great vessels
Infantile coarctation of the aorta

36. What artery is the 2nd most often occluded in an MI?
RCA
PGE
S epidermidis
1-3 days

37. What is diastolic dysfx?
Inability to fill ventricles
Opening snap followed by diastolic rumble
Ventricular arrhythmia
Small vegetations along the line of closure

38. What does rupture of a papillary muscle cause?
Osler nodes (ouch - ouch Osler)
Mitral insufficiency
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
4-7 days

39. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Infantile coarctation of the aorta
Papillary muscle - free wall - IV septum
Squatting - expiration

40. What is a water - hammer pulse?
Decreases LV dilation by decreasing volume
Bounding pulse
Loss of LV fx
Heart can't fill

41. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Hypertrophic cardiomyopathy
PGE
Aneurysm - mural thrombus - Dressler syndrome

42. What causes wear and tear aortic stenosis?
Valve replacement once LV dysfx develops
Fibrosis and dystrophic calcification
Atria and RV
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

43. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Decreased forward perfusion pulmonary congestion
Nitroglycerin
RCA
Bicuspid aortic valve

44. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
1-3 days
>70%
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

45. How do you tx prinzmetal angina?
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
Cardiogenic shock - CHF - arrhythmia
NG or Ca channel blocker
Red border granulation tissue

46. In which chamber of the heart are cardiac myxomas found?
ST- segment depression
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
LA
Rupture of free wall - IV septum - or papillary muscle

47. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Infectious endocarditis
Ventricle

48. What does rupture of the IV septum cause?
Granulation tissue
Friction rub and chest pain
Coexisting mitral stenosis and fusion of commisures exist
Shunt

49. What is the gold standard blood marker for MI?
MI
Troponin I
Tuberous sclerosis
Mitral regurgitation due to vegetations

50. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Right to left
Positive blood cultures anemia of chronic disease
Congestive heart failure