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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 type of shunt results in cyanosis at birth?
ACE inhibitor
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Right to left
Prinzmetal angina - cocaine

2. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Mitral valve prolapse
Heart can't fill
Mitral stenosis

3. What are the forward and backward sx of LHF?
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
Hypercoagulable state or underlying adenocarcinoma
Contraction band necrosis - reperfusion injury
NG or Ca channel blocker

4. What heart sound manifest with an ASD?
Metastasis
Low voltage EKG w/diminished QRS amplitude
Split S2 on auscultation
Ventricles cannot pump

5. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Infantile coarctation of the aorta PDA
CK- MB
Regurg vs stenosis
Atria and RV

6. How does adult coarctation of the aorta present?
Decrease preload -->lowers myocardial stress
4-7 days
Louder - increased systemic resistence decreases LV emptying
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

7. What is the tx for VSD?
45%
Surgical closure small defects may close spontaneously
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Granulation tissue

8. What does rupture of the IV septum cause?
ACE inhibitor
Shunt
Cardiogenic shock - CHF - arrhythmia
Stable and unstable prinzmetal

9. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
PGE
Open blocked vessels
Colon cancer
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

10. What is the most common form of cardiomyopathy?
Concentric LV hypertophy
Dilated
Prinzmetal stable and unstable
Coexisting mitral stenosis and fusion of commisures exist

11. What maintains patency of the PDA?
Sterile vegetations on surface and undersurface on mitral valve
PGE
Acute inflammation
Coronary artery vasospasm - emboli - vasculitis

12. Why are cardiac enzymes elevated after an MI?
Shunt - PGE to maintain PDA until surgical repair can be performed
Membrane damage
Maternal diabetes
S aureus

13. What increases the volume of mitral regurg murmur?
Spontaneous
Autoimmune pericarditis 6-8 wks post MI
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Squatting - expiration

14. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myxoma - benign
Fibrinous pericarditis

15. Dense layer of elastic and fibrotic tissue in the endocardium.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Pericarditits
Granulation tissue
Endocardial fibroelastosis

16. At what point in development do congenital heart defects arise?
3-8 wks
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral regurgitation due to vegetations

17. How does squating decrease hypoxemia in tetralogy of fallot?
Restrictive cardiomyopathy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
1-3 days out

18. What are heart failure cells?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Hemosiderin laden macrophages
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Shunt

19. What is molecular mimicry?
1-3 days
Cardiac tamponade
S epidermidis
When a bacterial protein resembles a protein in human tissue

20. What is a common complication of cardiac metastasis?
S aureus
Large vegetations of S aureus
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Pericardial effusion due to pericardial involvement

21. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Group A beta - hemolytic streptococci
Volume overload and LHF
Loss of LV fx

22. What gross and microscopic changes occur 4-24 hours after an MI?
Nitroglycerin
Dark discoloration coagulative necrosis
CK- MB
Split S2 on auscultation

23. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Stretched muscle loses contractility
4-7 days macrophage infiltration

24. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Left -->right
>60 years - bicuspid aortic valve
Mitral mitral+aortic

25. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
LA dilation
ASD - R-->L
Right -->left

26. What does Libman - Sacks endocarditis cause?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
LAD
Valve replacement once LV dysfx develops
Mitral regurg

27. What drug relieves stable angina?
Infectious endocarditis
Nitroglycerin
Loss of fx
Coronary artery vasospasm

28. What typically causes hypertrophic cardiomyopathy?
Janeway lesions
Osler nodes (ouch - ouch Osler)
AD mutation in sarcomere proteins
Loss of LV fx

29. How does stable angina present?
Pericardial effusion due to pericardial involvement
Ventricular arrhythmia
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Chest pain <20 min brought on by exertion or emotional stress

30. What compensatory mechanism do tetralogy of fallot pts learn?
Prinzmetal angina
Squat in response to cyanotic spell
Circumflex
Papillary muscle - free wall - IV septum

31. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Congenital rubella
Spontaneous
Wear and tear

32. Which vasculitis can cause MI?
Right -->left
Kawasaki disease
Maternal diabetes
Sterile vegetations on mitral valve along lines of closure

33. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myocarditis
Surgical closure small defects may close spontaneously
RCA

34. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Libman - Sacks endocarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Red border granulation tissue
Contraction band necrosis

35. What type of vegetations form in nonbacterial thrombotic endocarditis?
PDA
Sterile vegetations on mitral valve along lines of closure
2-3 weeks
Contraction band necrosis - reperfusion injury

36. When do macrophagess infiltrate the myocardium post MI?
Circumflex
4-7 days
Ventricular arrhythmia
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

37. What is systolic dysfx?
Ventricles cannot pump
Tetralogy of fallot
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Coronary artery vasospasm - emboli - vasculitis

38. What effect does aortic stenosis have on the chambers of the heart?
Posterior wall of LV - posterior septum - papillary muscles
Concentric LV hypertophy
Dense layer of elastic and fibrotic tissue in the endocardium - children
Harmartoma

39. What is the most common type of ASD? What %?
Ostium secundum (90%)
Mitral regurg
Transposition of the great vessels
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

40. What does rupture of the LV free wall cause?
Ostium primum
Infectious
Cardiac tamponade
Sterile vegetations on mitral valve along lines of closure

41. What does granulation tissue contain?
Mitral and tricuspid regurg - arrhythmia
Rhabdomyoma
Valve replacement once LV dysfx develops
Plump fibroblasts - collagen - blood vessels

42. What is the murmur of mitral regurg?
R-->L
Maternal diabetes
Holosystolic blowing murmur
Libman - Sacks endocarditis

43. When would arrhythmia occur after MI?
Within the first day
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral stenosis
Open blocked vessels

44. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

45. What is the most common tumor of the heart?
Minimizes ischemia
Opening snap followed by diastolic rumble
Months out fibrosis
Metastasis

46. What are the HACEK organisms? With what condition are they associated?
Anterior wall of LV and anterior septum
Loeffler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Shunt

47. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Wear and tear
VSD

48. Where is the coarctation in infantile coarctation of the aorta?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myocarditis
Stable and unstable prinzmetal
Preductal - post aortic arch

49. When is an MI pt at greatest risk for cardiogenic shock?
Anitschow cell
Atherosclerosis of coronary arteries
First 4 hours
Aschoff bodies

50. What does chronic ischemic heart disease progress to?
Reperfusion injury
Rhabdomyoma
Friction rub and chest pain
CHF