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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 etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Volume overload and LHF
Louder - increased systemic resistence decreases LV emptying
Cardiogenic shock - CHF - arrhythmia

2. Are most congenital heart defects spontaneous or inherited?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Congestive heart failure
Spontaneous
Coronary artery vasospasm - emboli - vasculitis

3. Where is the coarctation in infantile coarctation of the aorta?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Preductal - post aortic arch
Infectious
Stable angina

4. Why are cardiac enzymes elevated after an MI?
Chronic ischemic heart disease
Low voltage EKG w/diminished QRS amplitude
Decreased forward perfusion pulmonary congestion
Membrane damage

5. How does restrictive cardiomyopathy cause LHF?

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6. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Increased blood in right heart delays closure of P valve
Reactive histiocyte with caterpillar nucleus
Sterile vegetations on mitral valve along lines of closure
Louder - increased systemic resistence decreases LV emptying

7. What effect does mitral stenosis have on the heart chambers?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Chronic ischemic heart disease
LA dilation
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

8. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Prophylactic abx during dental procedures
Loss of LV fx
Sudden cardiac death
Regurg vs stenosis

9. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Type I
Metastasis
Mid - systolic click followed by regurgitation murmur

10. What is the effect of mitral regurg on the heart?
Doxorubicin - cocaine
Increased blood in right heart delays closure of P valve
Volume overload and LHF
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

11. Ostium primum ASD is associated with what congenital disorder?
PDA
Trisomy 21
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Blood vessels coming in from normal tissue

12. What cardiac enzyme is useful for detecting reinfarction?
Hypertrophic cardiomyopathy
Reperfusion injury
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
CK- MB

13. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Yellow pallor macrophages
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Anitschow cell
Preductal - post aortic arch

14. What are the complications of mitral valve prolapse? Are they common?
Kawasaki disease
Annular - non pruritic rash w/erythematous borders trunks and limbs
Ehlers - Danlow and Marfan syndrome
Infectious endocarditis - arrythmias - severe mitral regurg no

15. What are heart failure cells?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Hemosiderin laden macrophages
R-->L
Increased hydrostatic pressure

16. What are the sx of right - to - left shunt?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Cyanosis - RV hypertrophy - polycythemia - clubbing
Ischemic heart disease
Prophylactic abx during dental procedures

17. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Nonspecific - eg fever and elevated ESR
Valve scarring that arises as a consequence of rheumatic fever
Atherosclerosis of coronary arteries

18. How does ischemia cause LHF?
Coxsackie A or B
Positive blood cultures anemia of chronic disease
Harmartoma
Loss of fx

19. Sudden death in a young athlete.
Turner syndrome
Tetralogy of fallot
4-6 hours - 24 hours - 72 hours
Hypertrophic cardiomyopathy

20. What is Dressler syndrome? When does it occur?
Bicuspid aortic valve
Autoimmune pericarditis 6-8 wks post MI
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

21. What gross and microscopic changes occur 1-3 days after an MI?
Heart transplant
Pericarditits
Mitral and tricuspid regurg - arrhythmia
Yellow pallor neutrophils

22. What are the sx of pericardiits?
Months out fibrosis
Friction rub and chest pain
Mitral regurg
Hypertrophic cardiomyopathy

23. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Reactive histiocyte with caterpillar nucleus
Rhabdomyoma
Aortic stenosis

24. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Circumflex
Asymptomatic
Boot shaped heart

25. What does chronic ischemic heart disease progress to?
CHF
Bicuspid aortic valve
Atherosclerosis of coronary arteries
Contraction band necrosis - reperfusion injury

26. What congenital heart defect often is present with infantile coarctation of the aorta?
Tuberous sclerosis
Left -->right
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

27. What is the cause of restrictive cardiomyopathy in children?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Endocardial fibroelastosis (rare)
Volume overload and LHF
CHF

28. What is the murmur of mitral valve prolapse?
Turner syndrome
Granulation tissue
Mid - systolic click followed by regurgitation murmur
Pericardial effusion due to pericardial involvement

29. What is the gold standard blood marker for MI?
Troponin I
Maternal diabetes
LV dilation and eccentric hypertrophy
>70%

30. What are the tx for MI?
Cardiac tamponade
LV dilation and eccentric hypertrophy
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

31. 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.
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Stable angina
Reperfusion injury

32. Tender lesions on fingers or toes.
Doxorubicin - cocaine
Mitral stenosis
Slow HR - decreasing O2 demand and risk for arrhythmia
Osler nodes (ouch - ouch Osler)

33. How do you prevent S viridans endocarditis?
S aureus
Prophylactic abx during dental procedures
Infectious endocarditis
Low voltage EKG w/diminished QRS amplitude

34. What effect does dilated cardiomyopathy have on the heart?
Stable and unstable prinzmetal
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Systolic dysfx leading to biventricular CHF
PDA

35. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Intercostal arteries enlarged due to collateral circulation
Aortic regurg
When a bacterial protein resembles a protein in human tissue
Hypertrophic cardiomyopathy

36. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Opening snap followed by diastolic rumble
Open blocked vessels
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

37. Is injury due angina reversible or irreversible?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Chest pain <20 min brought on by exertion or emotional stress
Reversible
Nonspecific - eg fever and elevated ESR

38. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Intercostal arteries enlarged due to collateral circulation
Mitral regurg
Left -->right

39. What is the characteristic murmur of aortic stenosis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Systolic ejection click followed by crescendo - decrescendo murmur
LA dilation
White scar fibrosis

40. When would arrhythmia occur after MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infantile coarctation of the aorta
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Within the first day

41. Lower extremity cyanosis in infants? In adults?
Pancarditis
ST- segment depression
PDA
Infantile coarctation of the aorta PDA

42. What artery is the 2nd most often occluded in an MI?
RCA
Migratory polyarthritis
Acute inflammation
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

43. Is scar tissue or myocardium stronger?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myocardium
Split S2 on auscultation

44. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
RCA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

45. What is the rate of congenital heart defects?
Troponin I
1%
Months out fibrosis
Tuberous sclerosis

46. What iis the tx for aortic regurg?
Heart can't fill
ST- segment elevation
Shunt - PGE to maintain PDA until surgical repair can be performed
Valve replacement once LV dysfx develops

47. How does MI cause LHF?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Left -->right
Loss of LV fx
Ventricles cannot pump

48. When do macrophagess infiltrate the myocardium post MI?
Reversible
Shunt
4-7 days
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

49. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Sudden cardiac death

50. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myocarditis in acute rheumatic heart fever
Mitral regurg