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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 increases the risk for chronic rheumatic heart disease?
Heart can't fill
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Dressler syndrome
2-4 hours - 24 hours - 7-10 days

2. Which artery is most often occluded in an MI?
Valve replacement once LV dysfx develops
Degree of pulmonary artery stenosis
LAD
ST- segment elevation

3. What are the forward and backward sx of LHF?
Myxoma - benign
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
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
2-3 weeks

4. Which coronary artery supplies the anterior wall and anterior septum?
IV drug users
LAD
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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

5. What is systolic dysfx?
Ventricles cannot pump
PDA
Open blocked vessels
R-->L

6. What causes endocarditis of prosthetic valves?
Aneurysm - mural thrombus - Dressler syndrome
Limits thrombosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
S epidermidis

7. What are the clinical features of LHF due to?
CK- MB
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Decreased forward perfusion pulmonary congestion
Papillary muscle - free wall - IV septum

8. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Preductal - post aortic arch
Aschoff bodies
Infectious

9. What are complications of dilated cardiomyopathy?
Migratory polyarthritis
Mitral and tricuspid regurg - arrhythmia
Mitral mitral+aortic
Dilation of all four chambers of the heart

10. When would arrhythmia occur after MI?
Pts w/previously damaged valves
Increased blood in right heart delays closure of P valve
Tricuspid
Within the first day

11. What drug relieves stable angina?
Trisomy 21
Nitroglycerin
Pericarditits
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

12. What endocarditis is commonly found in patients with colon cancer?
Subendocardial
Turner syndrome
Streptococcus bovis/
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

13. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
VSD
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Hypertophy of RV atrophy of LV

14. What causes angina and syncope in aortic stenosis?

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15. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Positive blood cultures anemia of chronic disease
Holosystolic machine like murmur
Coexisting mitral stenosis and fusion of commisures exist
RCA

16. What is the main cause of MV regurg? What are other causes?
>60 years - bicuspid aortic valve
Maternal diabetes
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Migratory polyarthritis

17. What is the 1day-1wk -1mo mneumonic for MI?
Day 1-7
>70%
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Trisomy 21

18. What causes an early - blowing diastolic murmur?
RBC damaged while crossing the calcified valve causing schistocytes
Aortic regurg
Congestive heart failure
Group A beta - hemolytic streptococci

19. What is a water - hammer pulse?
Bounding pulse
Eisenmenger syndrome
Congestive heart failure
SLE

20. In which pts does S viridans cause endocarditits?
LAD
Pts w/previously damaged valves
Increased blood in right heart delays closure of P valve
Stable angina

21. What are the sx of cardiac myxoma?
Tuberous sclerosis
Metastasis
Ventricular arrhythmia
Pedunculated mass in the LA that causes syncope due to obstruction of MV

22. What congenital heart defect does indomethacin tx?
Stretched muscle loses contractility
Months out fibrosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
PDA

23. What is Dressler syndrome? When does it occur?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Autoimmune pericarditis 6-8 wks post MI
Intercostal arteries enlarged due to collateral circulation
Infantile coarctation of the aorta PDA

24. What are the complications of mitral valve prolapse? Are they common?
Endocardial fibroelastosis (rare)
Large - destructive vegetations
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral regurg

25. When does the heart have dark discoloration post MI?
LAD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
CK- MB
4-24 hours

26. What is an Aschoff body?
Membrane damage
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Infantile coarctation of the aorta PDA
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

27. Dilated cardiomyopathy is a late complication of what illness?
Chest pain <20 min brought on by exertion or emotional stress
Myocarditis
Dilated
Circumflex

28. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pericardial effusion due to pericardial involvement
LHF
Minimizes ischemia

29. What is the gold standard blood marker for MI?
Aschoff bodies
Autoimmune pericarditis 6-8 wks post MI
Troponin I
LAD

30. What type of shunt does transposition of the great vessels cause?
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
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Papillary muscle - free wall - IV septum

31. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Degree of pulmonary artery stenosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Nitroglycerin

32. What shunt does tetralogy of fallot produce?
Doxorubicin - cocaine
Right -->left
Stable angina
Red border granulation tissue

33. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Degree of pulmonary artery stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Left -->right

34. In which chamber of the heart are rhabdomyomas found?
Fibrinous pericarditis
Ventricle
Myxoma - benign
Mid - systolic click followed by regurgitation murmur

35. Why would cardiac enzymes continue to increase after the initial MI?
>70%
Coronary artery vasospasm
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Reperfusion injury

36. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Contraction band necrosis
Streptococcus viridans
Atherosclerosis of coronary arteries

37. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Endocardial fibroelastosis (rare)
Decreases LV dilation by decreasing volume
Dilation of all four chambers of the heart

38. How does ischemia cause LHF?
Infantile coarctation of the aorta
Loss of fx
Small vegetations along the line of closure
Heart can't fill

39. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Bounding pulse
Stretched muscle loses contractility
Cardiogenic shock - CHF - arrhythmia

40. What causes the split S2 in ASD?
Libman - Sacks endocarditis
Congestive heart failure
ACE inhibitor
Increased blood in right heart delays closure of P valve

41. Is injury due angina reversible or irreversible?
Surgical closure small defects may close spontaneously
Myxoma - benign
Infantile coarctation of the aorta
Reversible

42. When do troponin levels rise - peak - and return to normal?
Stable angina
Holosystolic blowing murmur
2-4 hours - 24 hours - 7-10 days
Mid - systolic click followed by regurgitation murmur

43. What causes unstable angina?
>70%
Chronic ischemic heart disease
Surgical closure small defects may close spontaneously
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

44. Are most congenital heart defects spontaneous or inherited?
Group A beta - hemolytic streptococci
Cardiogenic shock - CHF - arrhythmia
Congested central veins
Spontaneous

45. What two things cause coronary artery vasospasm?
Endocardial fibroelastosis
MI
Prinzmetal angina - cocaine
Annular - non pruritic rash w/erythematous borders trunks and limbs

46. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Cardiac tamponade
Stable angina
R-->L
Myxoid degeneration

47. What is the rate of congenital heart defects?
Infectious
Shunt - PGE to maintain PDA until surgical repair can be performed
1%
Endocarditis of prosthetic valves

48. What genetic conditions predispose a pt to mitral valve prolapse?
Pericarditits
Low voltage EKG w/diminished QRS amplitude
Erythematous nontender lesions on palms and soles.
Ehlers - Danlow and Marfan syndrome

49. What gross and microscopic changes occur 4-24 hours after an MI?
R-->L
Mitral regurgitation due to vegetations
VSD
Dark discoloration coagulative necrosis

50. With what developmental disorder is VSD associated?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Circumflex
Increased hydrostatic pressure
Fetal alcohol syndrome