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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 heart sound manifest with an ASD?
Libman - Sacks endocarditis
Dressler syndrome
Split S2 on auscultation
RCA

2. What is a complication of chronic rheumatic heart disease?
Heart can't fill
Within the first day
Infectious endocarditis
Valve replacement

3. What is the most common congenital heart defect?
Prinzmetal
S aureus
VSD
Fibrosis and dystrophic calcification

4. What is a water - hammer pulse?
Bounding pulse
Loss of LV fx
Chronic ischemic heart disease
Systolic dysfx leading to biventricular CHF

5. How does transmural MI/ischemia present on EKG?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
ST- segment elevation
Pericardial effusion due to pericardial involvement
Slow HR - decreasing O2 demand and risk for arrhythmia

6. What is the rate of mitral valve prolapse in the US?
2-3%
L->R
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

7. How does subendocardial MI/ischemia present on EKG?
Concentric LV hypertophy
PGE
Months out fibrosis
ST- segment depression

8. Boot - shaped heart on x- ray?
Tetralogy of fallot
Loeffler syndrome
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Heart can't fill

9. Tender lesions on fingers or toes.
Aortic stenosis
Regurg vs stenosis
Transesophageal echo
Osler nodes (ouch - ouch Osler)

10. What causes endocarditis of prosthetic valves?
Heart transplant
S epidermidis
Right side - serotonin and other secretory products detoxified in the lung
Congenital rubella

11. What type of vegetations are associated with Libman - Sacks endocarditis?
Tender lesions on fingers or toes.
Sterile vegetations on surface and undersurface on mitral valve
Pts w/previously damaged valves
Mitral regurg

12. What bug causes acute rheumatic fever?
Breast and lung carcinoma - melanoma - lymphoma
Harmartoma
Hypertrophic cardiomyopathy
Group A beta - hemolytic streptococci

13. What artery is the 2nd most often occluded in an MI?
PDA
RCA
Fibrinous pericarditis
Decreased forward perfusion pulmonary congestion

14. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Boot shaped heart
Infantile coarctation of the aorta
Decreases LV dilation by decreasing volume

15. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Loeffler syndrome
Dilated
Ehlers - Danlow and Marfan syndrome

16. What generally causes ischemic heart disease?
Pts w/previously damaged valves
Mitral insufficiency
Limits thrombosis
Atherosclerosis of coronary arteries

17. What type of shunt dose PDA cause?
Papillary muscle - free wall - IV septum
Left -->right
Mitral and tricuspid regurg - arrhythmia
S aureus

18. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Within the first day
RHF
VSD

19. With what condition are rhabdomyomas associated?
Pancarditis
AD mutation in sarcomere proteins
Tuberous sclerosis
Hypertrophic cardiomyopathy

20. What is the only Jones criteria that doesn't resolve with time?
Aneurysm - mural thrombus - Dressler syndrome
Pancarditis
Endocarditis of prosthetic valves
Reactive histiocyte with caterpillar nucleus

21. What makes the MV prolapse murmur louder? Why?
Mitral and tricuspid regurg - arrhythmia
Low voltage EKG w/diminished QRS amplitude
Surgical closure small defects may close spontaneously
Squatting - increased systemic resistence decreases LV emptying

22. Pericarditis 6-8 wks post MI.
Dressler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LAD
Nonspecific - eg fever and elevated ESR

23. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Hypertophy of RV atrophy of LV
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myocarditis

24. What valves are most commonly involved in chronic rheumatic heart disease?
Heart transplant
Mitral mitral+aortic
Sudden cardiac death
Small vegetations along the line of closure

25. When do CK- MB levels rise - peak - and return to normal?
Trisomy 21
4-6 hours - 24 hours - 72 hours
Turner syndrome
Tuberous sclerosis

26. What vavular defect results from acute rheumatic fever?
Valve scarring that arises as a consequence of rheumatic fever
Large - destructive vegetations
Intercostal arteries enlarged due to collateral circulation
Mitral regurgitation due to vegetations

27. What type of ischemia does stable angina cause?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Subendocardial
ST- segment depression
PDA

28. Infects predamaged valves after transient bacteremia?
S viridans
Limits thrombosis
Myofiber hypertrophy with disarray
Aortic regurg

29. With what disease is infantile coarctation of the aorta associated?
Sudden cardiac death
Turner syndrome
Increased hydrostatic pressure
Squatting - expiration

30. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
CK- MB
45%
Reactive histiocyte with caterpillar nucleus

31. What is systolic dysfx?
Mid - systolic click followed by regurgitation murmur
Mitral regurgitation due to vegetations
Ventricles cannot pump
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

32. What is the most common form of cardiomyopathy?
Preductal - post aortic arch
Dilated
>70%
Trisomy 21

33. What are the forward and backward sx of LHF?
Degree of pulmonary artery stenosis
Spontaneous
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
Osler nodes (ouch - ouch Osler)

34. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Large vegetations of S aureus
Myocarditis
Intercostal arteries enlarged due to collateral circulation

35. Tx for PDA?
Type I
Indomethacin - decreases PGE
RCA
Tender lesions on fingers or toes.

36. What is the most common cause of death during the acute phase of rheumatic fever?
Thickening of chrodae tendinae and cusps - mitral stenosis
Reperfusion injury
Holosystolic machine like murmur
Myocarditis

37. How does asprin/heparin tx MI?
Endocardial fibroelastosis
Granulation tissue
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Limits thrombosis

38. What effect does aortic stenosis have on the chambers of the heart?
Hypertrophic cardiomyopathy
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
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Concentric LV hypertophy

39. What is the murmur of mitral regurg?
L->R
Holosystolic blowing murmur
First 4 hours
Endocardial fibroelastosis

40. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Decrease in blood flow to an organ
Louder - increased systemic resistence decreases LV emptying
Loss of LV fx
Holosystolic blowing murmur

41. What type of endocarditis is associated with SLE?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Right side - serotonin and other secretory products detoxified in the lung
Stable angina
Libman - Sacks endocarditis

42. What is the leading cause of death in the US?
Infectious endocarditis
Ischemic heart disease
Sudden cardiac death
VSD

43. In which chamber of the heart are rhabdomyomas found?
Ventricle
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
S epidermidis
Mid - systolic click followed by regurgitation murmur

44. Friction rub and chest pain.
Prinzmetal angina - cocaine
Pericarditits
Pts w/previously damaged valves
S viridans

45. What always follows necrosis?
Cardiac tamponade
MI
Ehlers - Danlow and Marfan syndrome
Acute inflammation

46. What effect does transposition of the great vessels have on the ventricles?
Yellow pallor macrophages
Hypertophy of RV atrophy of LV
Reactive histiocyte with caterpillar nucleus
Contraction band necrosis

47. What gross and microscopic changes occur 4-24 hours after an MI?
Anterior wall of LV and anterior septum
Dark discoloration coagulative necrosis
RCA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

48. What are the complications of mitral stenosis?
Left -->right
Tuberous sclerosis
PDA
Backward LHF pulm htn and RHF - afib and associated mural thombis

49. What type of vegetations does Strep viridans cause?
Type I
Atherosclerosis of coronary arteries
Small - nondestructive vegetations (subacute endocarditis)
Indomethacin - decreases PGE

50. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Open blocked vessels
Mitral mitral+aortic
Systolic ejection click followed by crescendo - decrescendo murmur