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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. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Right to left
Dilation of all four chambers of the heart
Infantile coarctation of the aorta

2. What causes the split S2 in ASD?
PDA
Increased blood in right heart delays closure of P valve
Decrease in blood flow to an organ
ASD - R-->L

3. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Infantile coarctation of the aorta
Autoimmune pericarditis 6-8 wks post MI

4. When do CK- MB levels rise - peak - and return to normal?
1-3 days out
4-6 hours - 24 hours - 72 hours
VSD
Decrease in blood flow to an organ

5. What is the characteristic finding on CXR in tetralogy of fallot?
Valve replacement once LV dysfx develops
Boot shaped heart
Day 1-7
RHF

6. What causes notching of the ribs in adult coarctation of the aorta?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral insufficiency
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Intercostal arteries enlarged due to collateral circulation

7. What are the clinical features of endocarditis? What causes each feature?
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
Doxorubicin - cocaine
Sterile vegetations on surface and undersurface on mitral valve
Type I

8. How does restrictive cardiomyopathy present?
Congestive heart failure
S viridans
Regurg vs stenosis
Fibrosis and dystrophic calcification

9. What is systolic dysfx?
Fetal alcohol syndrome
Mitral insufficiency
Valve replacement
Ventricles cannot pump

10. Sudden death in a young athlete.
Concentric LV hypertophy
Friction rub and chest pain
Hypertrophic cardiomyopathy
Small vegetations along the line of closure

11. What is a complication of chronic rheumatic heart disease?
PDA
Valve replacement AFTER the onset of complications
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Infectious endocarditis

12. What is the tx for mitral valve prolapse?
Gelatinous - abundant ground substance
Wear and tear
S aureus
Valve replacement

13. What iis the tx for aortic regurg?
Decreases LV dilation by decreasing volume
Red border granulation tissue
Valve replacement once LV dysfx develops
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

14. What are the sx/complications of myocarditis?
Ostium secundum (90%)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
White scar fibrosis
Months out fibrosis

15. Vegetations on surface and undersurface of mitral valve.
Volume overload and LHF
Anterior wall of LV and anterior septum
Libman - Sacks endocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

16. What is the most common congenital heart defect?
Fetal alcohol syndrome
VSD
Elevated ASO anti - DNase B titers
Type I

17. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Tetralogy of fallot
Months out fibrosis
Acute inflammation
Contraction band necrosis

18. In what pt population does S aureus commonly cause valvular disease?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LA
IV drug users
Degree of pulmonary artery stenosis

19. How does reperfusion injury occur?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Hypertrophic cardiomyopathy
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
ASD - R-->L

20. What gross and microscopic changes occur 1-3 weeks after an MI?
Rhabdomyoma
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Red border granulation tissue
Coronary artery vasospasm

21. What type of tumor is a rhabdomyoma?
4-6 hours - 24 hours - 72 hours
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Boot shaped heart
Harmartoma

22. What is an Anitschow cell?
Subendocardial
Right -->left
Reactive histiocyte with caterpillar nucleus
20 min

23. What type of ischemia does stable angina cause?
Opening snap followed by diastolic rumble
Thickening of chrodae tendinae and cusps - mitral stenosis
Dressler syndrome
Subendocardial

24. With what endocarditis is S epidermidis associated?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aortic stenosis
Endocarditis of prosthetic valves
Eisenmenger syndrome

25. What is the tx for aortic stenosis?
Gelatinous - abundant ground substance
Valve replacement AFTER the onset of complications
Prophylactic abx during dental procedures
NG or Ca channel blocker

26. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Myxoid degeneration
>60 years - bicuspid aortic valve
Granulation tissue
Migratory polyarthritis

27. What does nonbacterial thrombotic endocarditis cause?
Bounding pulse
Mitral regurg
Infectious endocarditis
Minimizes ischemia

28. Ostium primum ASD is associated with what congenital disorder?
Dilation of all four chambers of the heart
2-3%
3-8 wks
Trisomy 21

29. What is a Quincke pulse?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Nitroglycerin
Pulsating nail bed
Rhadbomyoma - benign

30. What is the most common tumor of the heart?
Ehlers - Danlow and Marfan syndrome
Inability to fill ventricles
Infectious
Metastasis

31. Erythematous nontender lesions on palms and soles.
Coronary artery vasospasm
Libman - Sacks endocarditis
Nitroglycerin
Janeway lesions

32. How does O2 tx MI?
Ventricle
Minimizes ischemia
Cardiogenic shock - CHF - arrhythmia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

33. What murmur ccan be heard in PDA?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
4-7 days
Holosystolic machine like murmur
RHF

34. Is injury due angina reversible or irreversible?
Fibrinous pericarditis
Concentric LV hypertophy
Reversible
Cyanosis - RV hypertrophy - polycythemia - clubbing

35. What does rupture of a papillary muscle cause?
IV drug users
Valve replacement once LV dysfx develops
Mitral insufficiency
Inability to maintain systemic pressure w/lack of O2 to vital organs

36. How does aortic regurg affect the heart chambers?
Fibrosis and dystrophic calcification
LV dilation and eccentric hypertrophy
Elevated ASO anti - DNase B titers
Libman - Sacks endocarditis

37. What coronary arterysupplies the lateral wall of the LV?
Tetralogy of fallot
Circumflex
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Acute inflammation

38. What valves are involved in rhuematic endocarditis?
Aneurysm - mural thrombus - Dressler syndrome
Ostium secundum (90%)
Mitral mitral+aortic
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

39. Which artery is most often occluded in an MI?
2-3 weeks
Valve replacement AFTER the onset of complications
LAD
Libman - Sacks endocarditis

40. What type of valvular vegetations does S aureus cause?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Dressler syndrome
Erythematous nontender lesions on palms and soles.
Large - destructive vegetations

41. What is migratory polyarthritis?
Coxsackie A or B
Dark discoloration coagulative necrosis
Pericarditits
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

42. When is an MI pt at greatest risk for cardiogenic shock?
Heart can't fill
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Harmartoma
First 4 hours

43. In which chamber of the heart are cardiac myxomas found?
Nitroglycerin
LA
Friction rub and chest pain
Prinzmetal

44. What is typically the mechanims of sudden cardiac death?
Aortic regurg
Loss of LV fx
Ventricular arrhythmia
45%

45. What is the characteristic murmur of aortic stenosis?
45%
Circumflex
Systolic ejection click followed by crescendo - decrescendo murmur
Large - destructive vegetations

46. What is the rate of mitral valve prolapse in the US?
LA
Aortic regurg
CK- MB
2-3%

47. When do neutrophils infiltrate the myocardium post MI?
Pump failure
Infectious endocarditis - arrythmias - severe mitral regurg no
1%
1-3 days

48. What causes a mid - systolic click followed by a regurgitation murmur?
Mid - systolic click followed by regurgitation murmur
Yellow pallor macrophages
LA
Mitral valve prolapse

49. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Eisenmenger syndrome
Inability to maintain systemic pressure w/lack of O2 to vital organs
Hypertrophic cardiomyopathy

50. In which chamber of the heart are rhabdomyomas found?
PDA
Endocarditis of prosthetic valves
Ventricle
Loss of fx