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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 compensatory mechanism do tetralogy of fallot pts learn?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
2-3 weeks
LAD
Squat in response to cyanotic spell

2. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Spontaneous
Prinzmetal angina
Pericarditits
S aureus

3. What type of shunt does transposition of the great vessels cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
R-->L
Yellow pallor neutrophils
Tender lesions on fingers or toes.

4. What is the most common cause of endocarditis in IV drug users?
2-3 weeks
S aureus
Loss of LV fx
Rhabdomyoma

5. What is the most common form of cardiomyopathy?
Hypertrophic cardiomyopathy
Hypercoagulable state or underlying adenocarcinoma
Dilated
Valve replacement AFTER the onset of complications

6. What is a Quincke pulse?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
RBC damaged while crossing the calcified valve causing schistocytes
Pulsating nail bed
Plump fibroblasts - collagen - blood vessels

7. How does contraction band necrosis occur?
Low voltage EKG w/diminished QRS amplitude
Holosystolic blowing murmur
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Fetal alcohol syndrome

8. What type of endocarditis is associated with SLE?
Prinzmetal stable and unstable
Heart can't fill
Libman - Sacks endocarditis
First 4 hours

9. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Loeffler syndrome
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Transesophageal echo

10. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Trisomy 21
R-->L
Decreased forward perfusion pulmonary congestion

11. What is the only Jones criteria that doesn't resolve with time?
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
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Pancarditis

12. What is the murmur of mitral valve prolapse?
AD mutation in sarcomere proteins
Coronary artery vasospasm
Mid - systolic click followed by regurgitation murmur
Infectious endocarditis - arrythmias - severe mitral regurg no

13. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Mitral insufficiency
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
VSD
20 min

14. What are the causes of LHF?
Sudden cardiac death
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Streptococcus viridans
Decreased forward perfusion pulmonary congestion

15. What congenital heart defect presents later in life with lower extremity cyanosis?
Contraction band necrosis - reperfusion injury
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
AD mutation in sarcomere proteins
PDA

16. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Degree of pulmonary artery stenosis
Sterile vegetations on surface and undersurface on mitral valve
Months out fibrosis

17. What causes unstable angina?
Prinzmetal
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
LHF
Low voltage EKG w/diminished QRS amplitude

18. What effect does aortic regurg have on the pulse pressure? Why?
Open blocked vessels
Endocardial fibroelastosis
Decrease preload -->lowers myocardial stress
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

19. In what pt population does S aureus commonly cause valvular disease?
Slow HR - decreasing O2 demand and risk for arrhythmia
Squat in response to cyanotic spell
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
IV drug users

20. How does Eisenmeger syndrome occur?
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
Rhadbomyoma - benign
Slow HR - decreasing O2 demand and risk for arrhythmia
Red border granulation tissue

21. When would arrhythmia occur after MI?
Dressler syndrome
S aureus
Mitral mitral+aortic
Within the first day

22. What is diastolic dysfx?
Mitral stenosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Inability to fill ventricles
RCA

23. What are the HACEK organisms? With what condition are they associated?
Aneurysm - mural thrombus - Dressler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Ostium secundum (90%)
Rhabdomyoma

24. What causes prinzmetal angina?
Fetal alcohol syndrome
Congested central veins
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Coronary artery vasospasm

25. Which coronary artery supplies the anterior wall and anterior septum?
LAD
R-->L
LA
Surgical closure small defects may close spontaneously

26. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Mitral and tricuspid regurg - arrhythmia
RCA
Decrease preload -->lowers myocardial stress

27. What causes the dependent pitting edema in RHF?
Atria and RV
ST- segment depression
Blood vessels coming in from normal tissue
Increased hydrostatic pressure

28. What is the rate of mitral valve prolapse in the US?
Reperfusion injury
Dressler syndrome
2-3%
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

29. What cardiac enzyme is useful for detecting reinfarction?
Pancarditis
Prophylactic abx during dental procedures
S epidermidis
CK- MB

30. EKG for stable angina?
Stable and unstable prinzmetal
Aortic regurg
ST- segment depression
Type I

31. What effect does mitral stenosis have on the heart chambers?
Dilation of all four chambers of the heart
LA dilation
SLE
VSD

32. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
When a bacterial protein resembles a protein in human tissue
Limits thrombosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

33. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Fibrinous pericarditis
45%
>60 years - bicuspid aortic valve

34. Infects predamaged valves after transient bacteremia?
S viridans
Kawasaki disease
Transposition of the great vessels
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

35. What type of vegetations does Strep viridans cause?
Minimizes ischemia
Loeffler syndrome
PDA
Small - nondestructive vegetations (subacute endocarditis)

36. What is a common complication of cardiac metastasis?
MI
Stable angina
Pericardial effusion due to pericardial involvement
Right to left

37. What are the cancers that most commonly metastasize to the heart?
Endocarditis of prosthetic valves
Reversible
Fibrosis and dystrophic calcification
Breast and lung carcinoma - melanoma - lymphoma

38. What cardiac disease is associated with tuberous sclerosis?
Heart transplant
Rhabdomyoma
Intercostal arteries enlarged due to collateral circulation
Mitral mitral+aortic

39. Holosystolic blowing murmur that increases w/expiration?
Hemosiderin laden macrophages
Mitral regurg
Atria and RV
Red border granulation tissue

40. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
LHF
Pericarditits

41. Which congenital heart defect is associated with congenital rubella?
Loeffler syndrome
PDA
Valve replacement once LV dysfx develops
2-3%

42. What type of tumor is a rhabdomyoma?
Harmartoma
CHF
R-->L
Membrane damage

43. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Metastasis
Group A beta - hemolytic streptococci
Infectious endocarditis - arrythmias - severe mitral regurg no

44. What is an Aschoff body?
Endocarditis of prosthetic valves
Ostium primum
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
LA

45. With what disease is Libman - Sacks endocarditis associated?
1-3 days out
Tender lesions on fingers or toes.
SLE
Plump fibroblasts - collagen - blood vessels

46. What is the tx for LHF?
4-24 hours
Annular - non pruritic rash w/erythematous borders trunks and limbs
ACE inhibitor
Harmartoma

47. In transposition of the great vessels - What is required for survival? How is this achieved?
Adult coarctation of the aorta
Endocarditis of prosthetic valves
PDA
Shunt - PGE to maintain PDA until surgical repair can be performed

48. How does hypertension cause LHF?

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49. Is injury due angina reversible or irreversible?
Ehlers - Danlow and Marfan syndrome
Increased hydrostatic pressure
Reversible
Colon cancer

50. What are the sx of aortic regurg?
Dark discoloration coagulative necrosis
Mitral regurg
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Shunt - PGE to maintain PDA until surgical repair can be performed