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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 are Janeway lesions?
Split S2 on auscultation
Erythematous nontender lesions on palms and soles.
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
S aureus

2. What causes endocarditis of prosthetic valves?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Left -->right
S epidermidis
PDA

3. What conditions can cause nonbacterial thrombotic endocarditis?
Congenital rubella
Hypercoagulable state or underlying adenocarcinoma
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
MI

4. What are the sx of cardiac myxoma?
Preductal - post aortic arch
Mitral insufficiency
Pedunculated mass in the LA that causes syncope due to obstruction of MV
S aureus

5. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
2-3%
Right to left
Sterile vegetations on surface and undersurface on mitral valve

6. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
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
ST- segment elevation
Decreased forward perfusion pulmonary congestion

7. What are the complications that occur months after an MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Months out fibrosis
Aneurysm - mural thrombus - Dressler syndrome
Spontaneous

8. What type of shunt does ASD cause?
Decrease in blood flow to an organ
Left -->right
Loss of LV fx
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

9. Boot - shaped heart on x- ray?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral regurg
Tetralogy of fallot
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

10. With what congenital heart defect is ADULT coarctation of the aorta associated?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Bicuspid aortic valve
Group A beta - hemolytic streptococci
Inability to fill ventricles

11. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Yellow pallor neutrophils
Indomethacin - decreases PGE
Fibrinous pericarditis
Coexisting mitral stenosis and fusion of commisures exist

12. Vegetations on surface and undersurface of mitral valve.
Holosystolic blowing murmur
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Libman - Sacks endocarditis
Circumflex

13. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Contraction band necrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Bounding pulse

14. What are the two effects of ATII?
Myocardium
Pericardial effusion due to pericardial involvement
Mitral regurgitation due to vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

15. What is an Aschoff body?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Doxorubicin - cocaine
2-3 weeks
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

16. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Transesophageal echo
Metastasis

17. What structures are susceptible to rupture post MI?
Split S2 on auscultation
Papillary muscle - free wall - IV septum
Tender lesions on fingers or toes.
Ischemic heart disease

18. What is the most common cause of RHF? What are others?
Anterior wall of LV and anterior septum
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
White scar fibrosis
Hypertrophic cardiomyopathy

19. What is molecular mimicry?
Transposition of the great vessels
Heart transplant
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
When a bacterial protein resembles a protein in human tissue

20. What areas of the heart does the RCA supply?
Systolic dysfx leading to biventricular CHF
Adult coarctation of the aorta
Posterior wall of LV - posterior septum - papillary muscles
IV drug users

21. Large vegetations on tricuspid valve?
Ventricles cannot pump
S aureus
Right to left
Pts w/previously damaged valves

22. Why are cardiac enzymes elevated after an MI?
Membrane damage
S viridans
Breast and lung carcinoma - melanoma - lymphoma
Myofiber hypertrophy with disarray

23. How does stable angina present?
Coronary artery vasospasm
Chest pain <20 min brought on by exertion or emotional stress
S aureus
Decrease preload -->lowers myocardial stress

24. Ostium primum ASD is associated with what congenital disorder?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
RHF
Trisomy 21
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

25. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Left -->right
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Myocarditis

26. What is the characteristic murmur of aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Fibrosis and dystrophic calcification
Systolic ejection click followed by crescendo - decrescendo murmur
Yellow pallor macrophages

27. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Coxsackie A or B
Mid - systolic click followed by regurgitation murmur

28. What does chronic ischemic heart disease progress to?
PGE
CHF
CK- MB
Coronary artery vasospasm - emboli - vasculitis

29. With what disease is Libman - Sacks endocarditis associated?
SLE
LA dilation
Bounding pulse
Yellow pallor neutrophils

30. What is migratory polyarthritis?
Breast and lung carcinoma - melanoma - lymphoma
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dilation of all four chambers of the heart
IV drug users

31. Is scar tissue or myocardium stronger?
Large - destructive vegetations
Myocardium
ACE inhibitor
When a bacterial protein resembles a protein in human tissue

32. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Mitral regurg
S aureus
20 min
Aschoff bodies

33. Where is the coarctation in infantile coarctation of the aorta?
2-3 weeks
Preductal - post aortic arch
Infectious
Reperfusion injury

34. What is the characteristic finding on CXR in tetralogy of fallot?
Decrease in blood flow to an organ
Libman - Sacks endocarditis
Nitroglycerin
Boot shaped heart

35. What is a Quincke pulse?
Heart transplant
Pulsating nail bed
PGE
Pericardial effusion due to pericardial involvement

36. With what virus is PDA associated?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Congenital rubella
Squatting - increased systemic resistence decreases LV emptying
Chronic rheumatic heart disease

37. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Atherosclerosis of coronary arteries
1-3 days out
Posterior wall of LV - posterior septum - papillary muscles

38. What are other (not atherosclerotic) causes of MI?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Prophylactic abx during dental procedures
Coronary artery vasospasm - emboli - vasculitis
Rhadbomyoma - benign

39. What congenital heart defect is associated with fetal alcohol syndrome?
Mitral regurgitation due to vegetations
VSD
Regurg vs stenosis
Transposition of the great vessels

40. Sudden death in a young athlete.
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Heart can't fill
Hypertrophic cardiomyopathy
Fibrosis and dystrophic calcification

41. What are the tx for MI?
Mitral regurg
Hypercoagulable state or underlying adenocarcinoma
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral mitral+aortic

42. What is typically the mechanims of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ventricular arrhythmia
Myocarditis
Increased hydrostatic pressure

43. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Streptococcus bovis/
RCA
Months out fibrosis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

44. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Small vegetations along the line of closure
Tender lesions on fingers or toes.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

45. What valves are involved in rhuematic endocarditis?
Valve scarring that arises as a consequence of rheumatic fever
Mitral mitral+aortic
Dressler syndrome
IV drug users

46. Which angina(s) show ST elevation on EKG? ST depression?
Split S2 on auscultation
Circumflex
Streptococcus bovis/
Prinzmetal stable and unstable

47. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
VSD
Large vegetations of S aureus
Valve replacement

48. What are the four defects in tetralogy of fallot?
Stable and unstable prinzmetal
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
ACE inhibitor
Trisomy 21

49. What maintains patency of the PDA?
Rhadbomyoma - benign
PGE
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Decreased forward perfusion pulmonary congestion

50. Lower extremity cyanosis in infants? In adults?
Systemic venous congestion
Loeffler syndrome
Infantile coarctation of the aorta PDA
Nitroglycerin