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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 comon cause of aortic regurg? What are the other causes?
Chest pain <20 min brought on by exertion or emotional stress
Endocardial fibroelastosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Loeffler syndrome

2. What is the definition of ischemia?
Decrease in blood flow to an organ
Within the first day
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myocarditis

3. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Tricuspid
Ostium secundum (90%)
Red border granulation tissue

4. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Pts w/previously damaged valves
Months out fibrosis
Systemic venous congestion
20 min

5. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Transesophageal echo
Increased hydrostatic pressure
Nonbacterial thrombotic endocarditis (marantic endocarditis)

6. Poor myocardial fx due to chronic ischemic damage?
PDA
Colon cancer
Regurg vs stenosis
Chronic ischemic heart disease

7. What effect does aortic regurg have on the pulse pressure? Why?
PDA
>60 years - bicuspid aortic valve
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Within the first day

8. What are the tx for MI?
Increased blood in right heart delays closure of P valve
Granulation tissue
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Myocarditis

9. What causes acute endocarditis?
Pts w/previously damaged valves
Large vegetations of S aureus
1-3 days
Within the first day

10. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Right side - serotonin and other secretory products detoxified in the lung
Mid - systolic click followed by regurgitation murmur
Troponin I

11. What causes microangiopathic hemolytic anemia in aortic stenosis?
LAD
RBC damaged while crossing the calcified valve causing schistocytes
Thickening of chrodae tendinae and cusps - mitral stenosis
Minimizes ischemia

12. What is migratory polyarthritis?
Fetal alcohol syndrome
Stable angina
Granulation tissue
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

13. What is the most common cause of endocarditis in IV drug users?
S aureus
Loeffler syndrome
Nitroglycerin
Metastasis

14. When do macrophagess infiltrate the myocardium post MI?
RBC damaged while crossing the calcified valve causing schistocytes
4-7 days
LAD
AD mutation in sarcomere proteins

15. What murmur ccan be heard in PDA?
Squat in response to cyanotic spell
Holosystolic machine like murmur
Decrease in blood flow to an organ
Squatting - expiration

16. What are complications of dilated cardiomyopathy?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Mitral and tricuspid regurg - arrhythmia
Day 1-7
ASD - R-->L

17. What is the 1day-1wk -1mo mneumonic for MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Type I
3-8 wks
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

18. What are the two effects of ATII?
Spontaneous
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Fetal alcohol syndrome
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

19. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Prinzmetal angina - cocaine
Mitral insufficiency
Rhadbomyoma - benign

20. What effect does transposition of the great vessels have on the ventricles?
Pts w/previously damaged valves
L->R
>60 years - bicuspid aortic valve
Hypertophy of RV atrophy of LV

21. What is an important complication of ASD?
Eisenmenger syndrome
Papillary muscle - free wall - IV septum
Positive blood cultures anemia of chronic disease
Paradoxical emboli

22. What two things cause coronary artery vasospasm?
Mitral mitral+aortic
Prinzmetal angina - cocaine
S aureus
Tender lesions on fingers or toes.

23. EKG for stable angina?
Hemosiderin laden macrophages
ST- segment depression
Migratory polyarthritis
MI

24. What complications occur 4-7 days post MI?
Ehlers - Danlow and Marfan syndrome
Valve replacement AFTER the onset of complications
Mitral stenosis
Rupture of free wall - IV septum - or papillary muscle

25. What are the forward and backward sx of LHF?
Open blocked vessels
Restrictive cardiomyopathy
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
Fibrinous pericarditis

26. Infects predamaged valves after transient bacteremia?
Mitral regurg
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Louder - increased systemic resistence decreases LV emptying
S viridans

27. How does reperfusion injury occur?
Harmartoma
Nitroglycerin
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Inability to maintain systemic pressure w/lack of O2 to vital organs

28. What is the most common cause of infectious endocarditis?
Reactive histiocyte with caterpillar nucleus
CHF
Streptococcus viridans
Prinzmetal

29. What are the causes of LHF?
Holosystolic machine like murmur
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Split S2 on auscultation
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

30. What are the complications of mitral valve prolapse? Are they common?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Migratory polyarthritis
Ventricular arrhythmia
Infectious endocarditis - arrythmias - severe mitral regurg no

31. What is the most common cause of myocarditis?
Right -->left
Coxsackie A or B
Streptococcus bovis/
Aneurysm - mural thrombus - Dressler syndrome

32. With what virus is PDA associated?
Boot shaped heart
Pericardial effusion due to pericardial involvement
Libman - Sacks endocarditis
Congenital rubella

33. What always follows necrosis?
Acute inflammation
Decreased forward perfusion pulmonary congestion
RBC damaged while crossing the calcified valve causing schistocytes
Ventricular arrhythmia

34. What is the most common cause of aortic stenosis?
Right -->left
Wear and tear
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Left -->right

35. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Hypertrophic cardiomyopathy
Loss of fx
Nitroglycerin
Degree of pulmonary artery stenosis

36. What gross and microscopic changes occur 1-3 weeks after an MI?
Streptococcus bovis/
Wear and tear
Red border granulation tissue
Months out fibrosis

37. What are the complications of aortic stenosis?
4-6 hours - 24 hours - 72 hours
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
45%
Endocardial fibroelastosis

38. What characterizes acute rheumatic fever endocarditiis?
Endocardial fibroelastosis
Small vegetations along the line of closure
2-4 hours - 24 hours - 7-10 days
Transposition of the great vessels

39. What are the cancers that most commonly metastasize to the heart?
RCA
Streptococcus bovis/
Breast and lung carcinoma - melanoma - lymphoma
LV dilation and eccentric hypertrophy

40. In what pt population does S aureus commonly cause valvular disease?
IV drug users
R-->L
Prophylactic abx during dental procedures
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

41. What does rupture of a papillary muscle cause?
Mitral insufficiency
SLE
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
NG or Ca channel blocker

42. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Tender lesions on fingers or toes.
NG or Ca channel blocker
RHF

43. What is endocardial fibroelastosis? In what population is it found?
Indomethacin - decreases PGE
Prophylactic abx during dental procedures
Dense layer of elastic and fibrotic tissue in the endocardium - children
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

44. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Hypercoagulable state or underlying adenocarcinoma
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Indomethacin - decreases PGE
Aortic regurg

45. Which coronary artery supplies the anterior wall and anterior septum?
Mitral mitral+aortic
Spontaneous
Sterile vegetations on surface and undersurface on mitral valve
LAD

46. What vavular defect results from acute rheumatic fever?
Aortic regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Mitral regurgitation due to vegetations
Pedunculated mass in the LA that causes syncope due to obstruction of MV

47. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Myocarditis in acute rheumatic heart fever
Cyanosis - RV hypertrophy - polycythemia - clubbing
Pericardial effusion due to pericardial involvement

48. What is the most common congenital heart defect?
Tuberous sclerosis
VSD
RBC damaged while crossing the calcified valve causing schistocytes
Pericarditits

49. When would arrhythmia occur after MI?
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
Within the first day
Right -->left
Trisomy 21

50. What is the tx for LHF?
Kawasaki disease
Boot shaped heart
S epidermidis
ACE inhibitor