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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 type of shunt does a VSD cause?
L->R
Myocarditis
Decreases LV dilation by decreasing volume
LV dilation and eccentric hypertrophy

2. Tx for PDA?
Limits thrombosis
Ischemic heart disease
Indomethacin - decreases PGE
Endocardial fibroelastosis (rare)

3. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Hypertrophic cardiomyopathy
2-3%
Coronary artery vasospasm - emboli - vasculitis

4. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Shunt - PGE to maintain PDA until surgical repair can be performed
Prinzmetal angina - cocaine
Nitroglycerin

5. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
IV drug users
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Degree of pulmonary artery stenosis
20 min

6. What is dilated cardiomyopathy?
Ehlers - Danlow and Marfan syndrome
Fetal alcohol syndrome
Autoimmune pericarditis 6-8 wks post MI
Dilation of all four chambers of the heart

7. What effect does chronic rheumatic heart disease have the mitral valve?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Thickening of chrodae tendinae and cusps - mitral stenosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Aortic stenosis

8. What are the sx of right - to - left shunt?
Mitral regurgitation due to vegetations
Split S2 on auscultation
IV drug users
Cyanosis - RV hypertrophy - polycythemia - clubbing

9. What gross and microscopic changes occur 1-3 weeks after an MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
4-24 hours
Red border granulation tissue
LAD

10. Boot - shaped heart on x- ray?
Tetralogy of fallot
Bounding pulse
Low voltage EKG w/diminished QRS amplitude
LA

11. How does restrictive cardiomyopathy present?
Nitroglycerin
Reperfusion injury
Congestive heart failure
RBC damaged while crossing the calcified valve causing schistocytes

12. What is an important complication of ASD?
Mitral regurg
Ostium secundum (90%)
Paradoxical emboli
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

13. What shunt does tetralogy of fallot produce?
Right -->left
PDA
SLE
Ventricles cannot pump

14. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
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
Infectious
Janeway lesions

15. What type of vegetations are associated with Libman - Sacks endocarditis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Louder - increased systemic resistence decreases LV emptying
Cardiac tamponade
Sterile vegetations on surface and undersurface on mitral valve

16. What % stenosis causes stable angina?
Boot shaped heart
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
>70%
Circumflex

17. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Rhabdomyoma
Rhadbomyoma - benign
Degree of pulmonary artery stenosis
Large - destructive vegetations

18. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral valve prolapse
Tuberous sclerosis
Congenital rubella

19. What congenital heart defect often is present with infantile coarctation of the aorta?
Prophylactic abx during dental procedures
CHF
PDA
Large - destructive vegetations

20. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Turner syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Heart transplant

21. What is the JOneS mneumonic?
Atherosclerosis of coronary arteries
Hypertrophic cardiomyopathy
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
Decreased forward perfusion pulmonary congestion

22. What is endocardial fibroelastosis? In what population is it found?
Prophylactic abx during dental procedures
Positive blood cultures anemia of chronic disease
Sudden cardiac death
Dense layer of elastic and fibrotic tissue in the endocardium - children

23. What is the most common form of cardiomyopathy?
Troponin I
Dilated
VSD
Squatting - increased systemic resistence decreases LV emptying

24. What effect does dilated cardiomyopathy have on the heart?
LHF
Systemic venous congestion
Coronary artery vasospasm - emboli - vasculitis
Systolic dysfx leading to biventricular CHF

25. What is the main cause of MV regurg? What are other causes?
Months out fibrosis
AD mutation in sarcomere proteins
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Day 1-7

26. Friction rub and chest pain.
Acute inflammation
LA dilation
RBC damaged while crossing the calcified valve causing schistocytes
Pericarditits

27. What does a biopsy of hypertrophic cardiomyopathy look like?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
3-8 wks
Myofiber hypertrophy with disarray
Louder - increased systemic resistence decreases LV emptying

28. With what condition are rhabdomyomas associated?
Pericarditits
Surgical closure small defects may close spontaneously
Stable and unstable prinzmetal
Tuberous sclerosis

29. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
ACE inhibitor
Blood vessels coming in from normal tissue
Chronic rheumatic heart disease

30. What gross and microscopic changes occur 4-7 days after an MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Metastasis
Yellow pallor macrophages
>60 years - bicuspid aortic valve

31. What is the most comon cause of aortic regurg? What are the other causes?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Holosystolic blowing murmur
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Louder - increased systemic resistence decreases LV emptying

32. What complications occur within 4 hrs post MI?
Doxorubicin - cocaine
Prinzmetal angina
Slow HR - decreasing O2 demand and risk for arrhythmia
Cardiogenic shock - CHF - arrhythmia

33. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1-3 days
Fibrosis and dystrophic calcification
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

34. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Tricuspid
Atherosclerosis of coronary arteries
Small - nondestructive vegetations (subacute endocarditis)

35. What is the most common congenital heart defect?
Left -->right
AD mutation in sarcomere proteins
RBC damaged while crossing the calcified valve causing schistocytes
VSD

36. Infects predamaged valves after transient bacteremia?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
S viridans
When a bacterial protein resembles a protein in human tissue

37. Opening snap followed by diastolic rumble.
NG or Ca channel blocker
Aneurysm - mural thrombus - Dressler syndrome
Myxoma - benign
Mitral stenosis

38. What are the Jones criteria?
4-7 days
Hypertophy of RV atrophy of LV
Decreased forward perfusion pulmonary congestion
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

39. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Systolic dysfx leading to biventricular CHF
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Dilation of all four chambers of the heart

40. What type of shunt does transposition of the great vessels cause?
Coexisting mitral stenosis and fusion of commisures exist
Plump fibroblasts - collagen - blood vessels
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
R-->L

41. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
IV drug users
Contraction band necrosis
Libman - Sacks endocarditis

42. What is the basic principle of CHF?
Pump failure
Right -->left
Dilation of all four chambers of the heart
Mitral stenosis

43. What is the most common cause of endocarditis in IV drug users?
Chest pain <20 min brought on by exertion or emotional stress
S aureus
Pericardial effusion due to pericardial involvement
Ventricles cannot pump

44. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Fibrosis and dystrophic calcification
Contraction band necrosis
Mitral and tricuspid regurg - arrhythmia
Intercostal arteries enlarged due to collateral circulation

45. What are the sx of hypertrophic cardiomyopathy?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myxoma - benign
Inability to maintain systemic pressure w/lack of O2 to vital organs
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

46. What does chronic ischemic heart disease progress to?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Mitral regurg
Prinzmetal angina
CHF

47. What conditions can cause nonbacterial thrombotic endocarditis?
Dressler syndrome
Systolic ejection click followed by crescendo - decrescendo murmur
Open blocked vessels
Hypercoagulable state or underlying adenocarcinoma

48. What drug relieves stable angina?
Preductal - post aortic arch
ACE inhibitor
Nitroglycerin
Posterior wall of LV - posterior septum - papillary muscles

49. What makes the MV prolapse murmur louder? Why?
Regurg vs stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Squatting - increased systemic resistence decreases LV emptying
Tuberous sclerosis

50. What are the complications of mitral stenosis?
Aortic stenosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
20 min
Sterile vegetations on mitral valve along lines of closure