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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?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Atherosclerosis of coronary arteries
2-3 weeks
Rupture of free wall - IV septum - or papillary muscle

2. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Loeffler syndrome
Metastasis
>60 years - bicuspid aortic valve

3. What causes angina and syncope in aortic stenosis?

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4. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Friction rub and chest pain
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

5. How long after pharyngitis does acute rheumatic fever occur?
Volume overload and LHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Months out fibrosis
2-3 weeks

6. Are most congenital heart defects spontaneous or inherited?
MI
ST- segment depression
Breast and lung carcinoma - melanoma - lymphoma
Spontaneous

7. Tx for PDA?
VSD
Harmartoma
Coronary artery vasospasm
Indomethacin - decreases PGE

8. What is systolic dysfx?
Months out fibrosis
Streptococcus bovis/
Endocarditis of prosthetic valves
Ventricles cannot pump

9. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Group A beta - hemolytic streptococci
Hypercoagulable state or underlying adenocarcinoma
Myxoma - benign

10. 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
Heart can't fill
Holosystolic machine like murmur
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

11. How does adult coarctation of the aorta present?
Holosystolic machine like murmur
Dilated
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Squatting - increased systemic resistence decreases LV emptying

12. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Pts w/previously damaged valves
Dark discoloration coagulative necrosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

13. What are the complications that occur months after an MI?
Decreases LV dilation by decreasing volume
Shunt
Aneurysm - mural thrombus - Dressler syndrome
Myxoma - benign

14. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Yellow pallor macrophages
Asymptomatic

15. What areas of the heart does the LAD supply?
Aneurysm - mural thrombus - Dressler syndrome
Anterior wall of LV and anterior septum
CK- MB
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

16. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Intercostal arteries enlarged due to collateral circulation
Transesophageal echo
2-3 weeks

17. How does aortic regurg affect the heart chambers?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LV dilation and eccentric hypertrophy
Surgical closure small defects may close spontaneously
RCA

18. What are the sx of hypertrophic cardiomyopathy?
Myocarditis
Ventricle
Systolic ejection click followed by crescendo - decrescendo murmur
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

19. Myofiber hypertrophy with disarray.
Valve scarring that arises as a consequence of rheumatic fever
Hypertrophic cardiomyopathy
1%
Osler nodes (ouch - ouch Osler)

20. What is an important complication of ASD?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myxoid degeneration
PDA
Paradoxical emboli

21. What are the Jones criteria?
Rhadbomyoma - benign
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
2-4 hours - 24 hours - 7-10 days
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

22. What is the most common cause of dilated cardiomyopathy? What are other causes?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Bicuspid aortic valve
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

23. What is migratory polyarthritis?
LAD
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Aortic regurg
Pericardial effusion due to pericardial involvement

24. Is injury due angina reversible or irreversible?
Papillary muscle - free wall - IV septum
Slow HR - decreasing O2 demand and risk for arrhythmia
Migratory polyarthritis
Reversible

25. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Cyanosis - RV hypertrophy - polycythemia - clubbing
Aortic stenosis
S viridans

26. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
ST- segment elevation
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Autoimmune pericarditis 6-8 wks post MI

27. What genetic conditions predispose a pt to mitral valve prolapse?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Bicuspid aortic valve
Ehlers - Danlow and Marfan syndrome
Coxsackie A or B

28. How does fibrinolysis/angioplasty tx MI?
Libman - Sacks endocarditis
Gelatinous - abundant ground substance
Open blocked vessels
2-4 hours - 24 hours - 7-10 days

29. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Atria and RV
Type I
Valve scarring that arises as a consequence of rheumatic fever

30. Which congenital heart defect is associated with congenital rubella?
PDA
Holosystolic machine like murmur
20 min
Anitschow cell

31. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Right to left
Rupture of free wall - IV septum - or papillary muscle
Myxoma - benign
20 min

32. What is the most common form of cardiomyopathy?
RHF
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Contraction band necrosis
Dilated

33. Which angina(s) show ST elevation on EKG? ST depression?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
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 stable and unstable
Papillary muscle - free wall - IV septum

34. What causes endocarditis of prosthetic valves?
S epidermidis
PDA
Right side - serotonin and other secretory products detoxified in the lung
Regurg vs stenosis

35. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Nitroglycerin
Heart transplant
Aschoff bodies
Blood vessels coming in from normal tissue

36. When would arrhythmia occur after MI?
Within the first day
Hypertophy of RV atrophy of LV
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

37. What is Loeffler syndrome?
Infantile coarctation of the aorta
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Coronary artery vasospasm
Fibrinous pericarditis

38. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
RCA
Rupture of free wall - IV septum - or papillary muscle
Fibrinous pericarditis

39. What type of shunt does truncus arteriosus cause?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
R-->L
First 4 hours
Mitral and tricuspid regurg - arrhythmia

40. Which artery is most often occluded in an MI?
Small vegetations along the line of closure
LAD
2-3 weeks
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

41. What is a common complication of cardiac metastasis?
Blood vessels coming in from normal tissue
Pericardial effusion due to pericardial involvement
Sterile vegetations on surface and undersurface on mitral valve
Mid - systolic click followed by regurgitation murmur

42. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Bounding pulse
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Eisenmenger syndrome
Adult coarctation of the aorta

43. What is the most common cause of infectious endocarditis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Streptococcus viridans
Sterile vegetations on mitral valve along lines of closure
Stable and unstable prinzmetal

44. Tender lesions on fingers or toes.
Stable angina
Osler nodes (ouch - ouch Osler)
Valve replacement
Breast and lung carcinoma - melanoma - lymphoma

45. Ostium primum ASD is associated with what congenital disorder?
Inability to fill ventricles
Trisomy 21
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Dense layer of elastic and fibrotic tissue in the endocardium - children

46. What is the most common cause of endocarditis in IV drug users?
Granulation tissue
SLE
Bounding pulse
S aureus

47. What type of tumor is a rhabdomyoma?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Harmartoma
Hypertrophic cardiomyopathy
PGE

48. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
First 4 hours
Stable angina
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

49. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Coexisting mitral stenosis and fusion of commisures exist
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

50. What is the rate of mitral valve prolapse in the US?
IV drug users
Increased blood in right heart delays closure of P valve
2-3%
Open blocked vessels