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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 valvular vegetations does S aureus cause?
S epidermidis
Large - destructive vegetations
Loss of LV fx
Mid - systolic click followed by regurgitation murmur

2. What are the complications of mitral stenosis?
Cyanosis - RV hypertrophy - polycythemia - clubbing
RCA
Backward LHF pulm htn and RHF - afib and associated mural thombis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

3. Turner syndrome is associated with which congenital heart defect?
Systolic ejection click followed by crescendo - decrescendo murmur
CHF
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
Infantile coarctation of the aorta

4. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
S viridans
20 min
Shunt

5. What does granulation tissue contain?
Hypertrophic cardiomyopathy
Plump fibroblasts - collagen - blood vessels
Right to left
Bacterial endocarditis

6. What causes angina and syncope in aortic stenosis?

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7. What are the laboratory findings of bacterial endocarditis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Valve replacement once LV dysfx develops
Valve replacement AFTER the onset of complications
Positive blood cultures anemia of chronic disease

8. L- to - R shunt switching to R- to - L shunt.
Low voltage EKG w/diminished QRS amplitude
2-3 weeks
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Eisenmenger syndrome

9. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Ventricle
Reversible
Hemosiderin laden macrophages

10. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Within the first day
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

11. Which congenital heart defect is associated with congenital rubella?
Prinzmetal
PDA
Mitral stenosis
Ventricles cannot pump

12. What effect does transposition of the great vessels have on the ventricles?
Colon cancer
Hypertophy of RV atrophy of LV
S viridans
Large - destructive vegetations

13. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Erythematous nontender lesions on palms and soles.
Squatting - expiration
Months out fibrosis

14. Poor myocardial fx due to chronic ischemic damage?
Mitral valve prolapse
Chronic ischemic heart disease
Endocardial fibroelastosis
Myxoid degeneration

15. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
VSD
Coexisting mitral stenosis and fusion of commisures exist
Mitral and tricuspid regurg - arrhythmia
RCA

16. What type of shunt dose PDA cause?
Pump failure
Left -->right
Dilation of all four chambers of the heart
MI

17. What typically causes hypertrophic cardiomyopathy?
RCA
Dressler syndrome
AD mutation in sarcomere proteins
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

18. What is the effect of mitral regurg on the heart?
Ventricle
Squatting - increased systemic resistence decreases LV emptying
Dense layer of elastic and fibrotic tissue in the endocardium - children
Volume overload and LHF

19. What genetic conditions predispose a pt to mitral valve prolapse?
Opening snap followed by diastolic rumble
Ehlers - Danlow and Marfan syndrome
3-8 wks
Troponin I

20. What areas of the heart does the LAD supply?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Anterior wall of LV and anterior septum
Anitschow cell

21. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Prophylactic abx during dental procedures
CHF
Chronic ischemic heart disease

22. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Elevated ASO anti - DNase B titers
Mitral regurg
3-8 wks

23. With what endocarditis is S epidermidis associated?
Spontaneous
Kawasaki disease
Endocarditis of prosthetic valves
Anitschow cell

24. 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
Surgical closure small defects may close spontaneously
Loss of fx
S aureus

25. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Coronary artery vasospasm
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Anitschow cell

26. What is the basic principle of CHF?
Pump failure
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
2-3 weeks
Ostium primum

27. How does O2 tx MI?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Minimizes ischemia
Breast and lung carcinoma - melanoma - lymphoma
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

28. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia
Indomethacin - decreases PGE
ACE inhibitor

29. What causes the nutmeg color in nutmeg liver?
Atherosclerosis of coronary arteries
Congested central veins
ACE inhibitor
Acute inflammation

30. How does dilated cardiomyopathy cause LHF?
Janeway lesions
Stretched muscle loses contractility
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PDA

31. What is an important complication of ASD?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Paradoxical emboli
Mitral regurg
Aneurysm - mural thrombus - Dressler syndrome

32. How does ischemia cause LHF?
Yellow pallor neutrophils
Months out fibrosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Loss of fx

33. What coronary artery supplies the mitral valve papillary muscles?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
RCA
Maternal diabetes
Trisomy 21

34. What are the sx of right - to - left shunt?
Transesophageal echo
Slow HR - decreasing O2 demand and risk for arrhythmia
Cyanosis - RV hypertrophy - polycythemia - clubbing
Months out fibrosis

35. What structures are susceptible to rupture post MI?
S viridans
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement AFTER the onset of complications
Papillary muscle - free wall - IV septum

36. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Thickening of chrodae tendinae and cusps - mitral stenosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

37. What is the JOneS mneumonic?
ACE inhibitor
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
Squat in response to cyanotic spell
Cyanosis - RV hypertrophy - polycythemia - clubbing

38. What is dilated cardiomyopathy?
Thickening of chrodae tendinae and cusps - mitral stenosis
Prinzmetal
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Dilation of all four chambers of the heart

39. What are the complications of aortic stenosis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypertrophic cardiomyopathy
ACE inhibitor
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

40. At what point in development do congenital heart defects arise?
Pancarditis
Increased blood in right heart delays closure of P valve
3-8 wks
CHF

41. In which chamber of the heart are cardiac myxomas found?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
LA
Blood vessels coming in from normal tissue
Yellow pallor neutrophils

42. How does adult coarctation of the aorta present?
Dilation of all four chambers of the heart
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RCA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

43. What effect does mitral stenosis have on the heart chambers?
LHF
Day 1-7
LA dilation
Contraction band necrosis

44. What is the foundation of a scar?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
White scar fibrosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Granulation tissue

45. What congenital heart defect presents later in life with lower extremity cyanosis?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
PDA
Pts w/previously damaged valves
Stretched muscle loses contractility

46. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Shunt - PGE to maintain PDA until surgical repair can be performed
20 min
Decrease in blood flow to an organ
Inability to maintain systemic pressure w/lack of O2 to vital organs

47. What are the two effects of ATII?
4-6 hours - 24 hours - 72 hours
Coronary artery vasospasm
SLE
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

48. Which vasculitis can cause MI?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
4-24 hours
Kawasaki disease
Systemic venous congestion

49. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Spontaneous
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Squat in response to cyanotic spell

50. What is the most common tumor of the heart?
Opening snap followed by diastolic rumble
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
3-8 wks
Metastasis