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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 effect does dilated cardiomyopathy have on the heart?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Systolic dysfx leading to biventricular CHF
PDA
Asymptomatic

2. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Increased hydrostatic pressure
Stable and unstable prinzmetal
Mitral and tricuspid regurg - arrhythmia

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

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4. What causes microangiopathic hemolytic anemia in aortic stenosis?
Holosystolic machine like murmur
3-8 wks
Pts w/previously damaged valves
RBC damaged while crossing the calcified valve causing schistocytes

5. What is the rate of congenital heart defects?
>70%
Adult coarctation of the aorta
1%
Libman - Sacks endocarditis

6. What shunt does tetralogy of fallot produce?
Chest pain <20 min brought on by exertion or emotional stress
Opening snap followed by diastolic rumble
Right -->left
Endocardial fibroelastosis (rare)

7. What vavular defect results from acute rheumatic fever?
Mitral regurg
LHF
Libman - Sacks endocarditis
Mitral regurgitation due to vegetations

8. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
L->R

9. What are the sx of aortic regurg?
Fibrinous pericarditis
L->R
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

10. What valves are involved in rhuematic endocarditis?
Louder - increased systemic resistence decreases LV emptying
Minimizes ischemia
Mitral mitral+aortic
Mitral regurg

11. With what disease is transposition of the great vessels associated?
Maternal diabetes
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
Gelatinous - abundant ground substance
Months out fibrosis

12. What type of shunt does ASD cause?
RCA
Turner syndrome
Left -->right
Increased blood in right heart delays closure of P valve

13. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
LA dilation
Endocarditis of prosthetic valves
RBC damaged while crossing the calcified valve causing schistocytes

14. What are the complications of mitral valve prolapse? Are they common?
Months out fibrosis
RBC damaged while crossing the calcified valve causing schistocytes
Maternal diabetes
Infectious endocarditis - arrythmias - severe mitral regurg no

15. What gross and microscopic changes occur months after an MI?
Prinzmetal angina - cocaine
Myxoma - benign
Left -->right
White scar fibrosis

16. How does contraction band necrosis occur?
1-3 days
Mitral valve prolapse
Janeway lesions
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

17. With what condition are rhabdomyomas associated?
Tuberous sclerosis
VSD
Decrease in blood flow to an organ
Subendocardial

18. What are the complications of mitral stenosis?
Increased blood in right heart delays closure of P valve
MI
Louder - increased systemic resistence decreases LV emptying
Backward LHF pulm htn and RHF - afib and associated mural thombis

19. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Prophylactic abx during dental procedures
4-7 days
Stable angina

20. What are the sx/complications of myocarditis?
White scar fibrosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Yellow pallor neutrophils
Coronary artery vasospasm - emboli - vasculitis

21. How does dilated cardiomyopathy cause LHF?
Infectious endocarditis
Intercostal arteries enlarged due to collateral circulation
PDA
Stretched muscle loses contractility

22. Dense layer of elastic and fibrotic tissue in the endocardium.
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Harmartoma
Endocardial fibroelastosis
Decrease in blood flow to an organ

23. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
LAD
R-->L
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Left -->right

24. With what endocarditis is S epidermidis associated?
Restrictive cardiomyopathy
Backward LHF pulm htn and RHF - afib and associated mural thombis
Endocarditis of prosthetic valves
Doxorubicin - cocaine

25. Which artery is most often occluded in an MI?
LAD
Streptococcus viridans
Ostium primum
Chest pain <20 min brought on by exertion or emotional stress

26. What is the tx for aortic stenosis?
Infectious
Boot shaped heart
Valve replacement AFTER the onset of complications
Hypercoagulable state or underlying adenocarcinoma

27. Erythematous nontender lesions on palms and soles.
LA
Janeway lesions
Right to left
Type I

28. Opening snap followed by diastolic rumble.
Valve replacement
Mitral stenosis
Endocarditis of prosthetic valves
Endocardial fibroelastosis

29. What does nonbacterial thrombotic endocarditis cause?
ACE inhibitor
Mitral regurg
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ehlers - Danlow and Marfan syndrome

30. How does Eisenmeger syndrome occur?
MI
Mitral mitral+aortic
Granulation tissue
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

31. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Small - nondestructive vegetations (subacute endocarditis)
Reperfusion injury
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Transposition of the great vessels

32. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Thickening of chrodae tendinae and cusps - mitral stenosis
Surgical closure small defects may close spontaneously

33. What are the minor critera of the Jones criteria?
Contraction band necrosis - reperfusion injury
2-3%
Loss of LV fx
Nonspecific - eg fever and elevated ESR

34. What effect does chronic rheumatic heart disease have on the aortic valve?

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35. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Harmartoma
Left -->right
Reactive histiocyte with caterpillar nucleus

36. What is the characteristic finding on CXR in tetralogy of fallot?
Fetal alcohol syndrome
Volume overload and LHF
Pump failure
Boot shaped heart

37. Is scar tissue or myocardium stronger?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
1-3 days out
Myocardium
ASD - R-->L

38. EKG for stable angina?
Pericardial effusion due to pericardial involvement
Nitroglycerin
ST- segment depression
Limits thrombosis

39. What artery is the 2nd most often occluded in an MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
RCA
Myocardium
Bacterial endocarditis

40. Which coronary artery supplies the posterior wall of the LV and posterior septum?
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
Ischemic heart disease
RCA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

41. What does chronic ischemic heart disease progress to?
Myxoid degeneration
CHF
Congested central veins
Sterile vegetations on mitral valve along lines of closure

42. What generally causes ischemic heart disease?
Decrease preload -->lowers myocardial stress
Atherosclerosis of coronary arteries
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Ehlers - Danlow and Marfan syndrome

43. With what virus is PDA associated?
2-3%
Congenital rubella
Blood vessels coming in from normal tissue
2-4 hours - 24 hours - 7-10 days

44. What is the gold standard blood marker for MI?
Wear and tear
Troponin I
Prinzmetal stable and unstable
Gelatinous - abundant ground substance

45. What effect does aortic regurg have on the pulse pressure? Why?
Pts w/previously damaged valves
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
LA dilation
Bounding pulse

46. What are the causes of restrictive cardiomyopathy in adults?
4-6 hours - 24 hours - 72 hours
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
MI
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

47. What two things cause coronary artery vasospasm?
Myxoma - benign
Small - nondestructive vegetations (subacute endocarditis)
Prophylactic abx during dental procedures
Prinzmetal angina - cocaine

48. Tx for PDA?
Ischemic heart disease
Valve replacement once LV dysfx develops
Indomethacin - decreases PGE
S viridans

49. What is the most common cause of myocarditis?
Myofiber hypertrophy with disarray
Yellow pallor neutrophils
Right side - serotonin and other secretory products detoxified in the lung
Coxsackie A or B

50. What imaging test is useful for detecting lesions on valves?
Prophylactic abx during dental procedures
Adult coarctation of the aorta
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Transesophageal echo