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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 most common type of ASD? What %?
Sterile vegetations on mitral valve along lines of closure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Myocarditis
Ostium secundum (90%)

2. What is the most common cause of infectious endocarditis?
Loss of LV fx
Streptococcus viridans
Within the first day
S aureus

3. What are the cancers that most commonly metastasize to the heart?
Slow HR - decreasing O2 demand and risk for arrhythmia
Chronic rheumatic heart disease
Hypertrophic cardiomyopathy
Breast and lung carcinoma - melanoma - lymphoma

4. What gross and microscopic changes occur 1-3 weeks after an MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Osler nodes (ouch - ouch Osler)
Decrease preload -->lowers myocardial stress
Red border granulation tissue

5. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
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
Squat in response to cyanotic spell
Mid - systolic click followed by regurgitation murmur

6. Turner syndrome is associated with which congenital heart defect?
Loss of LV fx
Infantile coarctation of the aorta
Rupture of free wall - IV septum - or papillary muscle
Decrease in blood flow to an organ

7. How does transmural MI/ischemia present on EKG?
Open blocked vessels
Prinzmetal stable and unstable
Intercostal arteries enlarged due to collateral circulation
ST- segment elevation

8. How does O2 tx MI?
Open blocked vessels
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Reactive histiocyte with caterpillar nucleus
Minimizes ischemia

9. What drug relieves stable angina?
LV dilation and eccentric hypertrophy
Rupture of free wall - IV septum - or papillary muscle
Nitroglycerin
Bacterial endocarditis

10. Opening snap followed by diastolic rumble.
Aortic regurg
Pericarditits
Mitral stenosis
Nitroglycerin

11. What are Osler nodes?
Tender lesions on fingers or toes.
Holosystolic blowing murmur
Louder - increased systemic resistence decreases LV emptying
AD mutation in sarcomere proteins

12. What type of shunt dose PDA cause?
Left -->right
Mitral valve prolapse
ST- segment elevation
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

13. How does MI cause LHF?
Contraction band necrosis - reperfusion injury
Boot shaped heart
Loss of LV fx
Streptococcus viridans

14. Infects predamaged valves after transient bacteremia?
Rhadbomyoma - benign
Hypertrophic cardiomyopathy
S viridans
Mitral mitral+aortic

15. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Breast and lung carcinoma - melanoma - lymphoma
ASD - R-->L
Rhabdomyoma

16. How does subendocardial MI/ischemia present on EKG?
Trisomy 21
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ST- segment depression
Hypertophy of RV atrophy of LV

17. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Prinzmetal stable and unstable
Coexisting mitral stenosis and fusion of commisures exist
Heart can't fill

18. What are the major criteria of the Jones criteria?
Yellow pallor neutrophils
Prinzmetal angina - cocaine
Thickening of chrodae tendinae and cusps - mitral stenosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

19. With what endocarditis is S epidermidis associated?
Anterior wall of LV and anterior septum
Endocarditis of prosthetic valves
Stretched muscle loses contractility
Thickening of chrodae tendinae and cusps - mitral stenosis

20. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Valve replacement AFTER the onset of complications
>60 years - bicuspid aortic valve
AD mutation in sarcomere proteins
Small vegetations along the line of closure

21. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Adult coarctation of the aorta
Holosystolic blowing murmur
Large - destructive vegetations
Bacterial endocarditis

22. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
1-3 days
Bounding pulse
Ventricles cannot pump

23. What valves are most commonly involved in chronic rheumatic heart disease?
Aortic stenosis
Mitral mitral+aortic
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
RHF

24. Boot - shaped heart on x- ray?
Aneurysm - mural thrombus - Dressler syndrome
Degree of pulmonary artery stenosis
Tetralogy of fallot
Surgical closure small defects may close spontaneously

25. What are the sx of cardiac myxoma?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ehlers - Danlow and Marfan syndrome
Elevated ASO anti - DNase B titers

26. What is the only Jones criteria that doesn't resolve with time?
Plump fibroblasts - collagen - blood vessels
Troponin I
2-3 weeks
Pancarditis

27. What are the causes of restrictive cardiomyopathy in adults?
Decrease preload -->lowers myocardial stress
Stretched muscle loses contractility
Positive blood cultures anemia of chronic disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

28. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Migratory polyarthritis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Tuberous sclerosis

29. What heart sound manifest with an ASD?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Systolic ejection click followed by crescendo - decrescendo murmur
Turner syndrome
Split S2 on auscultation

30. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Squat in response to cyanotic spell
Valve replacement AFTER the onset of complications
Dense layer of elastic and fibrotic tissue in the endocardium - children

31. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Infectious endocarditis - arrythmias - severe mitral regurg no
Intercostal arteries enlarged due to collateral circulation
ST- segment depression

32. What type of tumor is a rhabdomyoma?
Ostium primum
Holosystolic blowing murmur
VSD
Harmartoma

33. What effect does chronic rheumatic heart disease have the mitral valve?
2-3%
Thickening of chrodae tendinae and cusps - mitral stenosis
Months out fibrosis
Preductal - post aortic arch

34. What is the cause of restrictive cardiomyopathy in children?
Split S2 on auscultation
Transposition of the great vessels
Endocardial fibroelastosis (rare)
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

35. What is diastolic dysfx?
LA dilation
Kawasaki disease
Ventricular arrhythmia
Inability to fill ventricles

36. What is cardiogenic shock?
Atria and RV
LHF
Inability to maintain systemic pressure w/lack of O2 to vital organs
Surgical closure small defects may close spontaneously

37. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Bacterial endocarditis
S epidermidis
Nonspecific - eg fever and elevated ESR
RHF

38. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Dilated
PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Nitroglycerin

39. What does rupture of the IV septum cause?
Mitral stenosis
Shunt
Right -->left
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

40. What is the most common form of cardiomyopathy?
Acute inflammation
4-7 days
Nonspecific - eg fever and elevated ESR
Dilated

41. What effect does mitral stenosis have on the heart chambers?
Right -->left
R-->L
White scar fibrosis
LA dilation

42. What are the complications that occur months after an MI?
Stretched muscle loses contractility
Aneurysm - mural thrombus - Dressler syndrome
Paradoxical emboli
NG or Ca channel blocker

43. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
When a bacterial protein resembles a protein in human tissue
MI
Infectious endocarditis - arrythmias - severe mitral regurg no
Holosystolic blowing murmur

44. What is the JOneS mneumonic?
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
Prinzmetal angina
Congenital rubella
Left -->right

45. What artery is the 2nd most often occluded in an MI?
Cardiogenic shock - CHF - arrhythmia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
RCA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

46. When is an MI pt at greatest risk for cardiogenic shock?
Cyanosis - RV hypertrophy - polycythemia - clubbing
First 4 hours
Mitral regurg
Stretched muscle loses contractility

47. What is a common complication of cardiac metastasis?
Granulation tissue
Pericardial effusion due to pericardial involvement
Prinzmetal
RCA

48. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
S aureus
Decreased forward perfusion pulmonary congestion
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

49. What is the foundation of a scar?
Left -->right
Systolic ejection click followed by crescendo - decrescendo murmur
Granulation tissue
L->R

50. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Mitral regurg
Louder - increased systemic resistence decreases LV emptying
4-7 days macrophage infiltration
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR