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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 drug relieves stable angina?
Mitral regurg
PDA
Preductal - post aortic arch
Nitroglycerin

2. What is the tx for dilated cardiomyopathy?
Heart transplant
Slow HR - decreasing O2 demand and risk for arrhythmia
ASD - R-->L
Inability to maintain systemic pressure w/lack of O2 to vital organs

3. In what pt population does S aureus commonly cause valvular disease?
Membrane damage
IV drug users
Low voltage EKG w/diminished QRS amplitude
Myxoma - benign

4. What causes endocarditis of prosthetic valves?
AD mutation in sarcomere proteins
Libman - Sacks endocarditis
S epidermidis
Systolic dysfx leading to biventricular CHF

5. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
2-4 hours - 24 hours - 7-10 days
RBC damaged while crossing the calcified valve causing schistocytes
RCA

6. What is the characteristic murmurr of mitral stenosis?
Mitral mitral+aortic
Bounding pulse
Opening snap followed by diastolic rumble
CHF

7. What complication occurs 1-3 days post MI?
Wear and tear
Hypertophy of RV atrophy of LV
Fibrinous pericarditis
Left -->right

8. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Infectious
Ehlers - Danlow and Marfan syndrome
Pericarditits

9. Low voltage EKG w/diminished QRS amplitude.
Valve replacement
Restrictive cardiomyopathy
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Mitral regurgitation due to vegetations

10. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral mitral+aortic
Prinzmetal angina - cocaine

11. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
ASD - R-->L
Hemosiderin laden macrophages
Inability to maintain systemic pressure w/lack of O2 to vital organs

12. Infects predamaged valves after transient bacteremia?
S viridans
Pancarditis
L->R
RCA

13. What increases the risk for chronic rheumatic heart disease?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Intercostal arteries enlarged due to collateral circulation
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Anterior wall of LV and anterior septum

14. What causes the nutmeg color in nutmeg liver?
Congested central veins
Hypercoagulable state or underlying adenocarcinoma
S epidermidis
Prinzmetal angina - cocaine

15. What endocarditis is commonly found in patients with colon cancer?
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
Streptococcus bovis/
CK- MB
Transesophageal echo

16. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Fetal alcohol syndrome
Mitral mitral+aortic
4-7 days
Prinzmetal angina

17. When do troponin levels rise - peak - and return to normal?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
2-4 hours - 24 hours - 7-10 days
Restrictive cardiomyopathy
Ehlers - Danlow and Marfan syndrome

18. How does restrictive cardiomyopathy present?
Streptococcus viridans
Congestive heart failure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
20 min

19. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Subendocardial
45%
Minimizes ischemia

20. What type of vegetations does Strep viridans cause?
Holosystolic blowing murmur
Small - nondestructive vegetations (subacute endocarditis)
Inability to maintain systemic pressure w/lack of O2 to vital organs
Infantile coarctation of the aorta

21. How does squating decrease hypoxemia in tetralogy of fallot?
ASD - R-->L
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Decrease preload -->lowers myocardial stress

22. What is the gold standard blood marker for MI?
First 4 hours
Congestive heart failure
Troponin I
Squat in response to cyanotic spell

23. Myofiber hypertrophy with disarray.
Dressler syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Hypertrophic cardiomyopathy
Kawasaki disease

24. What is Dressler syndrome? When does it occur?
Aortic regurg
ST- segment elevation
Autoimmune pericarditis 6-8 wks post MI
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

25. What two things cause coronary artery vasospasm?
2-4 hours - 24 hours - 7-10 days
Prinzmetal angina - cocaine
Split S2 on auscultation
Yellow pallor macrophages

26. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Mitral and tricuspid regurg - arrhythmia
Sterile vegetations on mitral valve along lines of closure

27. What type of tumor is a rhabdomyoma?
Harmartoma
Infectious
2-4 hours - 24 hours - 7-10 days
Contraction band necrosis

28. Erythematous nontender lesions on palms and soles.
Tender lesions on fingers or toes.
Autoimmune pericarditis 6-8 wks post MI
Janeway lesions
Asymptomatic

29. How does hypertension cause LHF?

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30. What is systolic dysfx?
ST- segment depression
Ventricles cannot pump
Cyanosis - RV hypertrophy - polycythemia - clubbing
Sudden cardiac death

31. What is the basic principle of CHF?
Pump failure
Infantile coarctation of the aorta
Decrease in blood flow to an organ
Contraction band necrosis

32. What is diastolic dysfx?
Inability to fill ventricles
Squatting - expiration
Blood vessels coming in from normal tissue
Ventricles cannot pump

33. What are the laboratory findings of bacterial endocarditis?
Rupture of free wall - IV septum - or papillary muscle
Positive blood cultures anemia of chronic disease
Squatting - expiration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

34. 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
Cardiogenic shock - CHF - arrhythmia
Tricuspid
Decreases LV dilation by decreasing volume

35. Why would cardiac enzymes continue to increase after the initial MI?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Valve replacement AFTER the onset of complications
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Reperfusion injury

36. Why are cardiac enzymes elevated after an MI?
Loss of fx
Months out fibrosis
Membrane damage
PDA

37. What structures are susceptible to rupture post MI?
Congestive heart failure
Papillary muscle - free wall - IV septum
ST- segment elevation
Louder - increased systemic resistence decreases LV emptying

38. With what virus is PDA associated?
Elevated ASO anti - DNase B titers
4-7 days macrophage infiltration
ASD - R-->L
Congenital rubella

39. With what condition are rhabdomyomas associated?
Tuberous sclerosis
LHF
Membrane damage
Infantile coarctation of the aorta PDA

40. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Decreases LV dilation by decreasing volume
Regurg vs stenosis
PDA

41. What is the effect of mitral regurg on the heart?
Split S2 on auscultation
Valve replacement AFTER the onset of complications
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Volume overload and LHF

42. In transposition of the great vessels - What is required for survival? How is this achieved?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Endocardial fibroelastosis (rare)
Fetal alcohol syndrome
Shunt - PGE to maintain PDA until surgical repair can be performed

43. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Adult coarctation of the aorta
Posterior wall of LV - posterior septum - papillary muscles
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

44. What cardiac enzyme is useful for detecting reinfarction?
Mid - systolic click followed by regurgitation murmur
LA
Hypertrophic cardiomyopathy
CK- MB

45. What are heart failure cells?
Libman - Sacks endocarditis
Decrease in blood flow to an organ
Fibrosis and dystrophic calcification
Hemosiderin laden macrophages

46. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Prophylactic abx during dental procedures
Regurg vs stenosis
1-3 days out
Fibrosis and dystrophic calcification

47. What disesase has Aschoff bodies?
Left -->right
Tricuspid
Myocarditis in acute rheumatic heart fever
Reperfusion injury

48. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Coronary artery vasospasm - emboli - vasculitis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Systolic dysfx leading to biventricular CHF
Anitschow cell

49. What are the major criteria of the Jones criteria?
Metastasis
Loeffler syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Sudden cardiac death

50. What two things happen when a blocked vessel is opened after an MI?
Tricuspid
Maternal diabetes
Contraction band necrosis - reperfusion injury
Coexisting mitral stenosis and fusion of commisures exist