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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 typically causes hypertrophic cardiomyopathy?
Cyanosis - RV hypertrophy - polycythemia - clubbing
AD mutation in sarcomere proteins
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
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

2. Tender lesions on fingers or toes.
Valve replacement AFTER the onset of complications
Osler nodes (ouch - ouch Osler)
Blood vessels coming in from normal tissue
Endocardial fibroelastosis

3. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Systemic venous congestion
Pericarditits
>60 years - bicuspid aortic valve
Bounding pulse

4. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Opening snap followed by diastolic rumble
Prinzmetal
SLE

5. What causes endocarditis of prosthetic valves?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
S epidermidis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Mitral regurg

6. What type of ischemia does stable angina cause?
Subendocardial
Decrease in blood flow to an organ
Coexisting mitral stenosis and fusion of commisures exist
Tetralogy of fallot

7. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Hemosiderin laden macrophages
Mitral stenosis
Coronary artery vasospasm

8. What causes mitral valve prolapse?
Harmartoma
Prophylactic abx during dental procedures
L->R
Myxoid degeneration

9. What is the leading cause of death in the US?
Heart transplant
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Ischemic heart disease
Congenital rubella

10. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Concentric LV hypertophy
Volume overload and LHF
Libman - Sacks endocarditis

11. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Limits thrombosis
Decrease preload -->lowers myocardial stress
Stable and unstable prinzmetal

12. What is Dressler syndrome? When does it occur?
Sterile vegetations on surface and undersurface on mitral valve
Autoimmune pericarditis 6-8 wks post MI
Maternal diabetes
Dense layer of elastic and fibrotic tissue in the endocardium - children

13. How does asprin/heparin tx MI?
Mitral regurgitation due to vegetations
Rhabdomyoma
Limits thrombosis
Squatting - increased systemic resistence decreases LV emptying

14. How does squating decrease hypoxemia in tetralogy of fallot?
Low voltage EKG w/diminished QRS amplitude
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
SLE

15. What is cardiogenic shock?
Left -->right
Endocardial fibroelastosis
Hemosiderin laden macrophages
Inability to maintain systemic pressure w/lack of O2 to vital organs

16. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Prophylactic abx during dental procedures
ASD - R-->L
Adult coarctation of the aorta
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

17. What is the tx for mitral valve prolapse?
Valve replacement
RCA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

18. How does dilated cardiomyopathy cause LHF?
LV dilation and eccentric hypertrophy
Shunt - PGE to maintain PDA until surgical repair can be performed
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Stretched muscle loses contractility

19. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Increased hydrostatic pressure
Boot shaped heart
Limits thrombosis
MI

20. In which chamber of the heart are cardiac myxomas found?
Dark discoloration coagulative necrosis
Janeway lesions
LA
Open blocked vessels

21. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
White scar fibrosis
Prinzmetal
Nitroglycerin
Atherosclerosis of coronary arteries

22. What are heart failure cells?
Aortic regurg
PDA
Hemosiderin laden macrophages
Bacterial endocarditis

23. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Infantile coarctation of the aorta PDA
LAD
Endocardial fibroelastosis (rare)

24. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Decrease preload -->lowers myocardial stress
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Adult coarctation of the aorta

25. What is the gold standard blood marker for MI?
Troponin I
Turner syndrome
Loss of fx
Transesophageal echo

26. What are the clinical features of endocarditis? What causes each feature?
Mitral stenosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
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
Open blocked vessels

27. How does hypertension cause LHF?

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28. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Congenital rubella
Contraction band necrosis
Infectious endocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

29. 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.
Osler nodes (ouch - ouch Osler)
RCA
Stable angina
Tender lesions on fingers or toes.

30. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
White scar fibrosis
Atherosclerosis of coronary arteries
Small - nondestructive vegetations (subacute endocarditis)

31. Ostium primum ASD is associated with what congenital disorder?
Ventricles cannot pump
Infectious
Trisomy 21
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

32. How do you tx prinzmetal angina?
Cardiac tamponade
Hypertrophic cardiomyopathy
Yellow pallor neutrophils
NG or Ca channel blocker

33. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Hemosiderin laden macrophages
Months out fibrosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

34. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
LA
NG or Ca channel blocker
Congenital rubella

35. What effect does transposition of the great vessels have on the ventricles?
Bicuspid aortic valve
Hypertophy of RV atrophy of LV
Aortic regurg
Hemosiderin laden macrophages

36. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Indomethacin - decreases PGE
Holosystolic machine like murmur
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

37. What is the definition of ischemia?
Decrease in blood flow to an organ
Infectious endocarditis
ACE inhibitor
Indomethacin - decreases PGE

38. Large vegetations on tricuspid valve?
S aureus
Mitral mitral+aortic
Sudden cardiac death
Blood vessels coming in from normal tissue

39. Opening snap followed by diastolic rumble.
PDA
LAD
>60 years - bicuspid aortic valve
Mitral stenosis

40. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Granulation tissue
Subendocardial
Aschoff bodies

41. What % stenosis causes stable angina?
Hemosiderin laden macrophages
Mid - systolic click followed by regurgitation murmur
>70%
Eisenmenger syndrome

42. What does rupture of the IV septum cause?
Pump failure
Shunt
Within the first day
Increased blood in right heart delays closure of P valve

43. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Yellow pallor macrophages
Congestive heart failure
Streptococcus bovis/

44. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Myocarditis in acute rheumatic heart fever
Yellow pallor neutrophils
Erythematous nontender lesions on palms and soles.
Loeffler syndrome

45. How do nitrates tx MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Decrease preload -->lowers myocardial stress
Elevated ASO anti - DNase B titers
Rhabdomyoma

46. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Preductal - post aortic arch
2-4 hours - 24 hours - 7-10 days
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

47. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Months out fibrosis
Myxoma - benign
Annular - non pruritic rash w/erythematous borders trunks and limbs

48. What compensatory mechanism do tetralogy of fallot pts learn?
Plump fibroblasts - collagen - blood vessels
Chronic rheumatic heart disease
Louder - increased systemic resistence decreases LV emptying
Squat in response to cyanotic spell

49. What drug relieves stable angina?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Nitroglycerin
Endocardial fibroelastosis
2-4 hours - 24 hours - 7-10 days

50. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
2-3%
Tuberous sclerosis
Friction rub and chest pain