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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. How does O2 tx MI?
Minimizes ischemia
Mid - systolic click followed by regurgitation murmur
Atria and RV
Months out fibrosis

2. How do you prevent S viridans endocarditis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prophylactic abx during dental procedures
Streptococcus bovis/
Tricuspid

3. With what disease is infantile coarctation of the aorta associated?
4-24 hours
Valve replacement AFTER the onset of complications
Turner syndrome
>70%

4. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Friction rub and chest pain
Erythematous nontender lesions on palms and soles.
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

5. What shunt does tetralogy of fallot produce?
LAD
Right -->left
Reperfusion injury
Pericarditits

6. What % of MIs involve the LAD?
Valve replacement
RCA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
45%

7. How does MI cause LHF?
Papillary muscle - free wall - IV septum
Loss of LV fx
Stable angina
Ventricular arrhythmia

8. What generally causes ischemic heart disease?
Libman - Sacks endocarditis
Breast and lung carcinoma - melanoma - lymphoma
Atherosclerosis of coronary arteries
4-7 days macrophage infiltration

9. What imaging test is useful for detecting lesions on valves?
Bacterial endocarditis
Annular - non pruritic rash w/erythematous borders trunks and limbs
VSD
Transesophageal echo

10. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Contraction band necrosis
ASD - R-->L
4-7 days macrophage infiltration

11. What type of valvular vegetations does S aureus cause?
Atria and RV
Large - destructive vegetations
Yellow pallor macrophages
Mitral valve prolapse

12. Pericarditis 6-8 wks post MI.
Anitschow cell
Chest pain <20 min brought on by exertion or emotional stress
Dressler syndrome
When a bacterial protein resembles a protein in human tissue

13. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Fibrosis and dystrophic calcification
Ventricle

14. What are the complications that occur months after an MI?
Paradoxical emboli
CK- MB
Volume overload and LHF
Aneurysm - mural thrombus - Dressler syndrome

15. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Large - destructive vegetations
Small vegetations along the line of closure
Hemosiderin laden macrophages

16. What does rupture of the IV septum cause?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Dressler syndrome
Shunt
Dark discoloration coagulative necrosis

17. What is the rate of congenital heart defects?
Right -->left
Ventricles cannot pump
Harmartoma
1%

18. When would arrhythmia occur after MI?
LA
Fetal alcohol syndrome
Sterile vegetations on mitral valve along lines of closure
Within the first day

19. What is molecular mimicry?
Right -->left
Months out fibrosis
When a bacterial protein resembles a protein in human tissue
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. How does asprin/heparin tx MI?
Endocarditis of prosthetic valves
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PDA
Limits thrombosis

21. What is the most common cause of endocarditis in IV drug users?
Trisomy 21
S aureus
Mitral regurgitation due to vegetations
Plump fibroblasts - collagen - blood vessels

22. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Prinzmetal angina
Dense layer of elastic and fibrotic tissue in the endocardium - children
Loss of fx

23. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Infectious endocarditis - arrythmias - severe mitral regurg no
Troponin I
Prinzmetal stable and unstable
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

24. What are the clinical features of endocarditis? What causes each feature?
Right side - serotonin and other secretory products detoxified in the lung
Eisenmenger syndrome
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
45%

25. How does transmural MI/ischemia present on EKG?
Metastasis
Valve replacement AFTER the onset of complications
ST- segment elevation
Infectious endocarditis - arrythmias - severe mitral regurg no

26. Tender lesions on fingers or toes.
Months out fibrosis
Blood vessels coming in from normal tissue
4-7 days macrophage infiltration
Osler nodes (ouch - ouch Osler)

27. In what pt population does S aureus commonly cause valvular disease?
4-7 days
Ventricle
Mitral valve prolapse
IV drug users

28. Sudden death in a young athlete.
Myxoid degeneration
ST- segment elevation
S aureus
Hypertrophic cardiomyopathy

29. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Spontaneous
Pts w/previously damaged valves
When a bacterial protein resembles a protein in human tissue

30. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
1-3 days
Increased blood in right heart delays closure of P valve
Stable and unstable prinzmetal

31. What is the characteristic murmur of aortic stenosis?
LHF
Systolic ejection click followed by crescendo - decrescendo murmur
Dilation of all four chambers of the heart
Decreased forward perfusion pulmonary congestion

32. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Streptococcus bovis/
Tender lesions on fingers or toes.
2-3%
Myxoma - benign

33. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Pulsating nail bed
Aschoff bodies
Maternal diabetes
SLE

34. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Infantile coarctation of the aorta
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
Heart transplant

35. What is the most common form of cardiomyopathy?
Tricuspid
Dilated
Osler nodes (ouch - ouch Osler)
2-3 weeks

36. How long after pharyngitis does acute rheumatic fever occur?
Hypercoagulable state or underlying adenocarcinoma
20 min
2-3 weeks
PDA

37. What drugs can cause dilated cardiomyopathy?
Streptococcus viridans
Troponin I
Harmartoma
Doxorubicin - cocaine

38. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Rhadbomyoma - benign
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Loeffler syndrome

39. With what endocarditis is S epidermidis associated?
Cardiogenic shock - CHF - arrhythmia
Nitroglycerin
Pulsating nail bed
Endocarditis of prosthetic valves

40. With what condition are rhabdomyomas associated?
Congenital rubella
RHF
Tuberous sclerosis
2-4 hours - 24 hours - 7-10 days

41. What areas of the heart does the RCA supply?
Rhabdomyoma
Holosystolic blowing murmur
Posterior wall of LV - posterior septum - papillary muscles
Circumflex

42. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Posterior wall of LV - posterior septum - papillary muscles
Stable angina
Anitschow cell

43. What murmur ccan be heard in PDA?
Aneurysm - mural thrombus - Dressler syndrome
Holosystolic machine like murmur
Congestive heart failure
Hemosiderin laden macrophages

44. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Infectious endocarditis
Heart transplant

45. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Louder - increased systemic resistence decreases LV emptying

46. What causes prinzmetal angina?
Infantile coarctation of the aorta
Small - nondestructive vegetations (subacute endocarditis)
Dense layer of elastic and fibrotic tissue in the endocardium - children
Coronary artery vasospasm

47. 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.
Large vegetations of S aureus
Stable angina
>70%
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

48. What causes acute endocarditis?
Yellow pallor neutrophils
Rhadbomyoma - benign
Loeffler syndrome
Large vegetations of S aureus

49. Systolic ejection click followed by crescendo - decrescendo murmur.
CK- MB
Aortic stenosis
Mid - systolic click followed by regurgitation murmur
Reperfusion injury

50. What is the most common cause of RHF? What are others?
Dressler syndrome
Left -->right
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome