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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 % stenosis causes stable angina?
VSD
ACE inhibitor
PDA
>70%

2. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Mitral mitral+aortic
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Stretched muscle loses contractility

3. How does stable angina present?
45%
Chest pain <20 min brought on by exertion or emotional stress
Cyanosis - RV hypertrophy - polycythemia - clubbing
When a bacterial protein resembles a protein in human tissue

4. Which coronary artery supplies the posterior wall of the LV and posterior septum?
LA
RCA
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Infectious

5. What increases the volume of mitral regurg murmur?
Squatting - expiration
Granulation tissue
Loss of LV fx
Endocarditis of prosthetic valves

6. What are the clinical features of RHF due to?
Hypertophy of RV atrophy of LV
Systemic venous congestion
Transesophageal echo
Dilated

7. With what disease is infantile coarctation of the aorta associated?
Granulation tissue
Louder - increased systemic resistence decreases LV emptying
Blood vessels coming in from normal tissue
Turner syndrome

8. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Valve scarring that arises as a consequence of rheumatic fever
Mitral and tricuspid regurg - arrhythmia
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

9. How does dilated cardiomyopathy cause LHF?
2-3%
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Anitschow cell
Stretched muscle loses contractility

10. EKG for stable angina?
2-3%
ST- segment depression
Small vegetations along the line of closure
R-->L

11. What is the most comon cause of aortic regurg? What are the other causes?
PDA
Autoimmune pericarditis 6-8 wks post MI
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

12. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Fetal alcohol syndrome
Months out fibrosis
Myofiber hypertrophy with disarray
Pulsating nail bed

13. When does the heart have dark discoloration post MI?
4-24 hours
2-3 weeks
Pericardial effusion due to pericardial involvement
Loeffler syndrome

14. What gross and microscopic changes occur 1-3 weeks after an MI?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Red border granulation tissue
Contraction band necrosis
R-->L

15. What is cardiogenic shock?
ST- segment depression
Myocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

16. What artery is the 2nd most often occluded in an MI?
Within the first day
LA
RCA
Colon cancer

17. What is the rate of congenital heart defects?
1%
PDA
Increased blood in right heart delays closure of P valve
VSD

18. What effect does mitral stenosis have on the heart chambers?
Infectious endocarditis
PGE
LA dilation
Backward LHF pulm htn and RHF - afib and associated mural thombis

19. Which congenital heart defect is associated with maternal diabetes?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Fibrosis and dystrophic calcification
Transposition of the great vessels
Loss of LV fx

20. In what pt population does S aureus commonly cause valvular disease?
Sterile vegetations on surface and undersurface on mitral valve
Boot shaped heart
IV drug users
Mitral stenosis

21. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Papillary muscle - free wall - IV septum
Libman - Sacks endocarditis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

22. Which vasculitis can cause MI?
Left -->right
Kawasaki disease
Myxoid degeneration
Contraction band necrosis

23. What are Janeway lesions?
Rhadbomyoma - benign
Erythematous nontender lesions on palms and soles.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Infantile coarctation of the aorta

24. With what congenital heart defect is ADULT coarctation of the aorta associated?
Heart transplant
Elevated ASO anti - DNase B titers
Loss of LV fx
Bicuspid aortic valve

25. How does reperfusion injury occur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
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

26. What are the tx for MI?
Split S2 on auscultation
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Shunt - PGE to maintain PDA until surgical repair can be performed
Spontaneous

27. How does O2 tx MI?
Minimizes ischemia
Shunt
Hypertrophic cardiomyopathy
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

28. What is a water - hammer pulse?
20 min
PGE
Bounding pulse
Ehlers - Danlow and Marfan syndrome

29. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
>70%
Annular - non pruritic rash w/erythematous borders trunks and limbs

30. What tests show prior group A beta - hemolytic strep infection?
Dilated
Elevated ASO anti - DNase B titers
Bacterial endocarditis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

31. When is an MI pt at greatest risk for cardiogenic shock?
Papillary muscle - free wall - IV septum
First 4 hours
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Endocardial fibroelastosis (rare)

32. Large vegetations on tricuspid valve?
LAD
ST- segment elevation
ASD - R-->L
S aureus

33. What is the characteristic murmur of aortic stenosis?
Infantile coarctation of the aorta
Systolic ejection click followed by crescendo - decrescendo murmur
Concentric LV hypertophy
Regurg vs stenosis

34. What causes heart failure cells?
Mitral regurg
Minimizes ischemia
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Paradoxical emboli

35. What causes endocarditis of prosthetic valves?
Decreases LV dilation by decreasing volume
Minimizes ischemia
Hypercoagulable state or underlying adenocarcinoma
S epidermidis

36. What is the most common type of ASD? What %?
Mitral regurg
Ostium secundum (90%)
Adult coarctation of the aorta
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

37. What are the HACEK organisms? With what condition are they associated?
Anitschow cell
Concentric LV hypertophy
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

38. What does nonbacterial thrombotic endocarditis cause?
Pulsating nail bed
PDA
Mitral regurg
Cardiogenic shock - CHF - arrhythmia

39. Sudden death in a young athlete.
LA
Systemic venous congestion
Coronary artery vasospasm
Hypertrophic cardiomyopathy

40. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Right to left
Streptococcus bovis/
45%

41. What cardiac disease is associated with tuberous sclerosis?
Kawasaki disease
Asymptomatic
Rhabdomyoma
Tricuspid

42. What coronary artery supplies the mitral valve papillary muscles?
Backward LHF pulm htn and RHF - afib and associated mural thombis
S aureus
Volume overload and LHF
RCA

43. What is the rate of mitral valve prolapse in the US?
R-->L
2-3%
20 min
Breast and lung carcinoma - melanoma - lymphoma

44. What is the most common tumor of the heart?
Coronary artery vasospasm - emboli - vasculitis
Transposition of the great vessels
Metastasis
Ventricles cannot pump

45. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myofiber hypertrophy with disarray
Sudden cardiac death
Nonbacterial thrombotic endocarditis (marantic endocarditis)

46. What does Libman - Sacks endocarditis cause?
Mitral regurg
Decrease preload -->lowers myocardial stress
Bacterial endocarditis
Dilated

47. Friction rub and chest pain.
First 4 hours
Group A beta - hemolytic streptococci
Pericarditits
Squatting - increased systemic resistence decreases LV emptying

48. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
ST- segment depression
LA
Fibrinous pericarditis
>60 years - bicuspid aortic valve

49. What is the basic principle of CHF?
Pump failure
4-7 days
Systemic venous congestion
Systolic dysfx leading to biventricular CHF

50. What is the JOneS mneumonic?
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
Spontaneous
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Intercostal arteries enlarged due to collateral circulation