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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 form of cardiomyopathy?
Mitral regurgitation due to vegetations
Dilated
Decrease preload -->lowers myocardial stress
Aschoff bodies

2. What type of shunt does transposition of the great vessels cause?
Colon cancer
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Prinzmetal
R-->L

3. What causes the nutmeg color in nutmeg liver?
Congested central veins
Plump fibroblasts - collagen - blood vessels
Tricuspid
Prophylactic abx during dental procedures

4. What causes an early - blowing diastolic murmur?
Aortic regurg
Myxoma - benign
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
Cardiac tamponade

5. When do neutrophils infiltrate the myocardium post MI?
Large - destructive vegetations
R-->L
1-3 days
Membrane damage

6. What is cardiogenic shock?
Chronic ischemic heart disease
LV dilation and eccentric hypertrophy
Inability to maintain systemic pressure w/lack of O2 to vital organs
Sterile vegetations on mitral valve along lines of closure

7. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Metastasis
Streptococcus viridans
Trisomy 21

8. What are the sx of cardiac myxoma?
Concentric LV hypertophy
Day 1-7
RBC damaged while crossing the calcified valve causing schistocytes
Pedunculated mass in the LA that causes syncope due to obstruction of MV

9. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Tetralogy of fallot
2-3 weeks
Breast and lung carcinoma - melanoma - lymphoma

10. What does rupture of the LV free wall cause?
Cardiac tamponade
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Membrane damage
LA dilation

11. What congenital heart defect presents later in life with lower extremity cyanosis?
Decreases LV dilation by decreasing volume
When a bacterial protein resembles a protein in human tissue
Harmartoma
PDA

12. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Mitral regurgitation due to vegetations
Infectious
Nonbacterial thrombotic endocarditis (marantic endocarditis)
NG or Ca channel blocker

13. With what disease is Libman - Sacks endocarditis associated?
SLE
Aortic regurg
S aureus
Tender lesions on fingers or toes.

14. What type of vegetations form in nonbacterial thrombotic endocarditis?
Group A beta - hemolytic streptococci
Sterile vegetations on surface and undersurface on mitral valve
Coronary artery vasospasm
Sterile vegetations on mitral valve along lines of closure

15. With what congenital heart defect is ADULT coarctation of the aorta associated?
Squat in response to cyanotic spell
PDA
When a bacterial protein resembles a protein in human tissue
Bicuspid aortic valve

16. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Endocardial fibroelastosis (rare)
Gelatinous - abundant ground substance
20 min
ACE inhibitor

17. What typically causes hypertrophic cardiomyopathy?
Stretched muscle loses contractility
AD mutation in sarcomere proteins
Infantile coarctation of the aorta
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

18. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Rupture of free wall - IV septum - or papillary muscle
Tetralogy of fallot
Granulation tissue

19. With what condition are rhabdomyomas associated?
3-8 wks
Asymptomatic
Tuberous sclerosis
Squat in response to cyanotic spell

20. How does stable angina present?
Concentric LV hypertophy
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
ACE inhibitor
Chest pain <20 min brought on by exertion or emotional stress

21. Poor myocardial fx due to chronic ischemic damage?
Dilation of all four chambers of the heart
Janeway lesions
Chronic ischemic heart disease
1%

22. What type of shunt does a VSD cause?
L->R
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Systemic venous congestion
1-3 days

23. What is dilated cardiomyopathy?
PDA
Dilation of all four chambers of the heart
Low voltage EKG w/diminished QRS amplitude
Libman - Sacks endocarditis

24. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Yellow pallor macrophages
LHF
Loss of LV fx
Indomethacin - decreases PGE

25. L- to - R shunt switching to R- to - L shunt.
Cyanosis - RV hypertrophy - polycythemia - clubbing
MI
Eisenmenger syndrome
Ventricle

26. What is the foundation of a scar?
Decrease in blood flow to an organ
ACE inhibitor
Right -->left
Granulation tissue

27. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
RCA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

28. What is migratory polyarthritis?
Infantile coarctation of the aorta
Reactive histiocyte with caterpillar nucleus
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Circumflex

29. How does asprin/heparin tx MI?
Squatting - increased systemic resistence decreases LV emptying
Membrane damage
Limits thrombosis
Papillary muscle - free wall - IV septum

30. What causes endocarditis of prosthetic valves?
Pericardial effusion due to pericardial involvement
S epidermidis
Yellow pallor neutrophils
45%

31. What effect does transposition of the great vessels have on the ventricles?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Thickening of chrodae tendinae and cusps - mitral stenosis
Hypertophy of RV atrophy of LV
ST- segment depression

32. What is a water - hammer pulse?
IV drug users
Aortic regurg
Bounding pulse
Shunt

33. What are the cancers that most commonly metastasize to the heart?
Hypertophy of RV atrophy of LV
Systemic venous congestion
Breast and lung carcinoma - melanoma - lymphoma
Infectious

34. What are the sx of pericardiits?
Indomethacin - decreases PGE
Mitral mitral+aortic
Pulsating nail bed
Friction rub and chest pain

35. What creates the immune reaction in acute rhuematic fever?

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36. What bug causes acute rheumatic fever?
Right to left
Infantile coarctation of the aorta
Split S2 on auscultation
Group A beta - hemolytic streptococci

37. What murmur ccan be heard in PDA?
LAD
CK- MB
Holosystolic machine like murmur
Preductal - post aortic arch

38. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Adult coarctation of the aorta
ASD - R-->L
Tricuspid

39. What effect does mitral stenosis have on the heart chambers?
Prinzmetal angina - cocaine
LA dilation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Group A beta - hemolytic streptococci

40. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Hypercoagulable state or underlying adenocarcinoma
Louder - increased systemic resistence decreases LV emptying
Cyanosis - RV hypertrophy - polycythemia - clubbing
Pancarditis

41. What are the minor critera of the Jones criteria?
Congenital rubella
Concentric LV hypertophy
Reactive histiocyte with caterpillar nucleus
Nonspecific - eg fever and elevated ESR

42. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Months out fibrosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Colon cancer

43. 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.
Paradoxical emboli
Stable angina
Eisenmenger syndrome
RCA

44. What is the effect of mitral regurg on the heart?
Tricuspid
Volume overload and LHF
Hypertrophic cardiomyopathy
Pericarditits

45. When is an MI patent at highest risk for fibrionous pericarditis?
Loss of LV fx
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1-3 days out
Bicuspid aortic valve

46. What type of valvular vegetations does S aureus cause?
PDA
Valve replacement once LV dysfx develops
Large - destructive vegetations
Dilated

47. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Thickening of chrodae tendinae and cusps - mitral stenosis
Aschoff bodies
Migratory polyarthritis
ST- segment depression

48. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
ACE inhibitor
4-7 days
Adult coarctation of the aorta
LA dilation

49. What is the most common cause of mitral stenosis?
Myocardium
Decrease in blood flow to an organ
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
Chronic rheumatic heart disease

50. How does hypertension cause LHF?

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