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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 are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Congested central veins
Atria and RV
Pancarditis

2. What is the most common congenital heart defect?
Ostium secundum (90%)
VSD
Decrease in blood flow to an organ
Day 1-7

3. What heart sound manifest with an ASD?
Fibrinous pericarditis
4-6 hours - 24 hours - 72 hours
Circumflex
Split S2 on auscultation

4. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Opening snap followed by diastolic rumble
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Elevated ASO anti - DNase B titers
Increased blood in right heart delays closure of P valve

5. Vegetations on surface and undersurface of mitral valve.
Coronary artery vasospasm
Ostium secundum (90%)
Libman - Sacks endocarditis
ST- segment depression

6. What type of shunt does transposition of the great vessels cause?
Myxoma - benign
R-->L
Intercostal arteries enlarged due to collateral circulation
Congestive heart failure

7. How does MI cause LHF?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
LA dilation
Loss of LV fx
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

8. When do neutrophils infiltrate the myocardium post MI?
Mid - systolic click followed by regurgitation murmur
Valve replacement once LV dysfx develops
1-3 days
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

9. What type of ASD is associated w/Down syndrome?
Ventricular arrhythmia
Heart can't fill
Adult coarctation of the aorta
Ostium primum

10. In which chamber of the heart are rhabdomyomas found?
Mitral valve prolapse
Within the first day
ASD - R-->L
Ventricle

11. What iis the tx for aortic regurg?
Ventricular arrhythmia
Valve replacement once LV dysfx develops
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Janeway lesions

12. What % of MIs involve the LAD?
PDA
45%
RCA
Autoimmune pericarditis 6-8 wks post MI

13. What causes notching of the ribs in adult coarctation of the aorta?
Reperfusion injury
Aneurysm - mural thrombus - Dressler syndrome
Intercostal arteries enlarged due to collateral circulation
Rupture of free wall - IV septum - or papillary muscle

14. With what disease is Libman - Sacks endocarditis associated?
Regurg vs stenosis
SLE
Boot shaped heart
Coronary artery vasospasm - emboli - vasculitis

15. What are the sx/complications of myocarditis?
Coronary artery vasospasm
Harmartoma
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Libman - Sacks endocarditis

16. What typically causes hypertrophic cardiomyopathy?
Minimizes ischemia
Months out fibrosis
Transesophageal echo
AD mutation in sarcomere proteins

17. What increases the volume of mitral regurg murmur?
Squatting - expiration
Valve replacement once LV dysfx develops
Osler nodes (ouch - ouch Osler)
Valve scarring that arises as a consequence of rheumatic fever

18. How does transmural MI/ischemia present on EKG?
ST- segment depression
ST- segment elevation
Small - nondestructive vegetations (subacute endocarditis)
Posterior wall of LV - posterior septum - papillary muscles

19. Infects predamaged valves after transient bacteremia?
Systolic dysfx leading to biventricular CHF
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
S viridans

20. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Rhadbomyoma - benign
Left -->right
Nitroglycerin
PDA

21. What type of ischemia does stable angina cause?
Subendocardial
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
CHF
Volume overload and LHF

22. At what point in development do congenital heart defects arise?
3-8 wks
Infectious endocarditis - arrythmias - severe mitral regurg no
2-4 hours - 24 hours - 7-10 days
S aureus

23. When do troponin levels rise - peak - and return to normal?
Gelatinous - abundant ground substance
4-7 days
Pts w/previously damaged valves
2-4 hours - 24 hours - 7-10 days

24. What effect does mitral stenosis have on the heart chambers?
RCA
LA dilation
Fetal alcohol syndrome
Reactive histiocyte with caterpillar nucleus

25. What is the 1day-1wk -1mo mneumonic for MI?
VSD
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Right -->left
1-3 days out

26. What does rupture of the IV septum cause?
Shunt
LV dilation and eccentric hypertrophy
Squat in response to cyanotic spell
Bacterial endocarditis

27. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
3-8 wks
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Adult coarctation of the aorta
PDA

28. In what pt population does S aureus commonly cause valvular disease?
Stable angina
Blood vessels coming in from normal tissue
IV drug users
PGE

29. 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.
Stable angina
S viridans
Acute inflammation
Ventricles cannot pump

30. What is endocardial fibroelastosis? In what population is it found?
4-6 hours - 24 hours - 72 hours
RCA
Dense layer of elastic and fibrotic tissue in the endocardium - children
Slow HR - decreasing O2 demand and risk for arrhythmia

31. When is an MI pt at greatest risk for cardiogenic shock?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Fibrinous pericarditis
First 4 hours
Rupture of free wall - IV septum - or papillary muscle

32. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Left -->right
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

33. What is the gold standard blood marker for MI?
Mitral regurg
Yellow pallor macrophages
1-3 days
Troponin I

34. Tx for PDA?
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
Mitral insufficiency
Indomethacin - decreases PGE
Coronary artery vasospasm

35. What % stenosis causes stable angina?
RBC damaged while crossing the calcified valve causing schistocytes
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Contraction band necrosis - reperfusion injury
>70%

36. Pericarditis 6-8 wks post MI.
Dressler syndrome
Mitral regurg
Turner syndrome
Regurg vs stenosis

37. What are the cancers that most commonly metastasize to the heart?
Decreases LV dilation by decreasing volume
Breast and lung carcinoma - melanoma - lymphoma
Prinzmetal stable and unstable
Prinzmetal angina - cocaine

38. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Mitral stenosis
Membrane damage
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral insufficiency

39. Ostium primum ASD is associated with what congenital disorder?
1%
Trisomy 21
Coronary artery vasospasm - emboli - vasculitis
Infantile coarctation of the aorta

40. What maintains patency of the PDA?
Inability to maintain systemic pressure w/lack of O2 to vital organs
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
PGE
Ostium primum

41. What are the complications that occur months after an MI?
Regurg vs stenosis
Aneurysm - mural thrombus - Dressler syndrome
Chest pain <20 min brought on by exertion or emotional stress
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

42. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Holosystolic blowing murmur
>60 years - bicuspid aortic valve
Nonspecific - eg fever and elevated ESR
Janeway lesions

43. What gross and microscopic changes occur 1-3 weeks after an MI?
Blood vessels coming in from normal tissue
IV drug users
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Red border granulation tissue

44. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
VSD
4-7 days
Colon cancer
VSD

45. How do nitrates tx MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
S epidermidis
Decrease preload -->lowers myocardial stress
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

46. How do you tx prinzmetal angina?
1-3 days
Acute inflammation
NG or Ca channel blocker
Right to left

47. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Dilation of all four chambers of the heart
Endocarditis of prosthetic valves
Colon cancer
Bacterial endocarditis

48. What is the most common cause of endocarditis in IV drug users?
Subendocardial
Chest pain <20 min brought on by exertion or emotional stress
ST- segment depression
S aureus

49. When is an MI patent at highest risk for fibrionous pericarditis?
4-6 hours - 24 hours - 72 hours
Valve replacement once LV dysfx develops
Ventricles cannot pump
1-3 days out

50. L- to - R shunt switching to R- to - L shunt.
S viridans
Eisenmenger syndrome
Hypertrophic cardiomyopathy
Streptococcus viridans