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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 complications occur 4-7 days post MI?
Coexisting mitral stenosis and fusion of commisures exist
Rupture of free wall - IV septum - or papillary muscle
Congenital rubella
Myocardium

2. Vegetations on surface and undersurface of mitral valve.
Boot shaped heart
Pancarditis
Coexisting mitral stenosis and fusion of commisures exist
Libman - Sacks endocarditis

3. What is the most common cause of dilated cardiomyopathy? What are other causes?
Acute inflammation
Trisomy 21
Fibrinous pericarditis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

4. Which angina(s) show ST elevation on EKG? ST depression?
Within the first day
Prinzmetal stable and unstable
Inability to maintain systemic pressure w/lack of O2 to vital organs
R-->L

5. What is the JOneS mneumonic?
Squat in response to cyanotic spell
Systolic dysfx leading to biventricular CHF
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
White scar fibrosis

6. With what disease is Libman - Sacks endocarditis associated?
Systolic dysfx leading to biventricular CHF
Yellow pallor macrophages
SLE
Positive blood cultures anemia of chronic disease

7. What does rupture of a papillary muscle cause?
Myocarditis
Mitral regurg
Reperfusion injury
Mitral insufficiency

8. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
45%
Pts w/previously damaged valves
Shunt

9. What are the cancers that most commonly metastasize to the heart?
Ventricular arrhythmia
RBC damaged while crossing the calcified valve causing schistocytes
Breast and lung carcinoma - melanoma - lymphoma
Mitral regurg

10. How does asprin/heparin tx MI?
PDA
Valve replacement
2-3 weeks
Limits thrombosis

11. What structures are susceptible to rupture post MI?
2-3%
Anterior wall of LV and anterior septum
Papillary muscle - free wall - IV septum
LA

12. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Right to left
Endocardial fibroelastosis
4-6 hours - 24 hours - 72 hours

13. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Stable angina
VSD
Tricuspid

14. What is the basic principle of CHF?
PDA
Streptococcus viridans
Valve replacement
Pump failure

15. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
White scar fibrosis
When a bacterial protein resembles a protein in human tissue
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

16. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rhadbomyoma - benign
Stable angina

17. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
S viridans
Libman - Sacks endocarditis
Pancarditis

18. How long after pharyngitis does acute rheumatic fever occur?
Heart can't fill
Transposition of the great vessels
Congestive heart failure
2-3 weeks

19. How does squating decrease hypoxemia in tetralogy of fallot?
S viridans
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Eisenmenger syndrome
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

20. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Decrease preload -->lowers myocardial stress
Hemosiderin laden macrophages
Anitschow cell

21. What is the gross and microscopic appearance of cardiac myxomas?
Systolic ejection click followed by crescendo - decrescendo murmur
ST- segment depression
Infectious endocarditis
Gelatinous - abundant ground substance

22. Which chambers of the heart are generally spared in an MI?
LAD
Atria and RV
RCA
Membrane damage

23. What is eythema marginatum? What parts of the body does it commonly involve?
Prophylactic abx during dental procedures
Annular - non pruritic rash w/erythematous borders trunks and limbs
Granulation tissue
Metastasis

24. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Acute inflammation
4-7 days
Nitroglycerin
Coronary artery vasospasm

25. Where is the coarctation in infantile coarctation of the aorta?
Congestive heart failure
Asymptomatic
Pts w/previously damaged valves
Preductal - post aortic arch

26. What causes acute endocarditis?
Osler nodes (ouch - ouch Osler)
Large vegetations of S aureus
2-4 hours - 24 hours - 7-10 days
Yellow pallor neutrophils

27. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Surgical closure small defects may close spontaneously
MI
S aureus
Myocarditis in acute rheumatic heart fever

28. Infects predamaged valves after transient bacteremia?
S viridans
PGE
Annular - non pruritic rash w/erythematous borders trunks and limbs
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

29. Which artery is most often occluded in an MI?
Valve replacement once LV dysfx develops
Hemosiderin laden macrophages
LAD
Pericarditits

30. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Small vegetations along the line of closure
RCA

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.
Thickening of chrodae tendinae and cusps - mitral stenosis
Tuberous sclerosis
Mitral stenosis
Stable angina

32. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Maternal diabetes
Squatting - expiration
Loss of LV fx

33. Holosystolic blowing murmur that increases w/expiration?
Sterile vegetations on mitral valve along lines of closure
Mitral regurg
Pulsating nail bed
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

34. What effect does transposition of the great vessels have on the ventricles?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Hypertophy of RV atrophy of LV
Hemosiderin laden macrophages
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

35. What type of vegetations does Strep viridans cause?
Prophylactic abx during dental procedures
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hypertrophic cardiomyopathy
Small - nondestructive vegetations (subacute endocarditis)

36. Which vasculitis can cause MI?
Kawasaki disease
Concentric LV hypertophy
LAD
Group A beta - hemolytic streptococci

37. What does chronic ischemic heart disease progress to?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Infectious endocarditis - arrythmias - severe mitral regurg no
CHF
Plump fibroblasts - collagen - blood vessels

38. When would arrhythmia occur after MI?
Within the first day
Mitral regurg
Tuberous sclerosis
Kawasaki disease

39. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Yellow pallor macrophages
Months out fibrosis
Surgical closure small defects may close spontaneously

40. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Open blocked vessels
Annular - non pruritic rash w/erythematous borders trunks and limbs
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

41. When do macrophagess infiltrate the myocardium post MI?
Adult coarctation of the aorta
Aortic regurg
4-7 days
4-7 days macrophage infiltration

42. What is the foundation of a scar?
PDA
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Granulation tissue
AD mutation in sarcomere proteins

43. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
S aureus
PDA
Rhadbomyoma - benign

44. How do ACE inhibitors tx MI?
Squatting - expiration
Decreases LV dilation by decreasing volume
ST- segment elevation
Coronary artery vasospasm - emboli - vasculitis

45. What does nonbacterial thrombotic endocarditis cause?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Left -->right
Prophylactic abx during dental procedures
Mitral regurg

46. What type of shunt does a VSD cause?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Stable and unstable prinzmetal
ACE inhibitor
L->R

47. Sudden death in a young athlete.
L->R
Mitral mitral+aortic
Hypertrophic cardiomyopathy
2-4 hours - 24 hours - 7-10 days

48. What is the most common cause of endocarditis in IV drug users?
Metastasis
Heart can't fill
S aureus
Group A beta - hemolytic streptococci

49. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
SLE
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Day 1-7

50. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Myxoid degeneration
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Valve scarring that arises as a consequence of rheumatic fever
LHF