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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 Dressler syndrome? When does it occur?
Ventricles cannot pump
LV dilation and eccentric hypertrophy
Autoimmune pericarditis 6-8 wks post MI
Contraction band necrosis - reperfusion injury

2. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Coxsackie A or B
Myocardium
Nitroglycerin
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

3. What is the tx for VSD?
Volume overload and LHF
Decrease preload -->lowers myocardial stress
Surgical closure small defects may close spontaneously
Streptococcus bovis/

4. What is the most common cause of death during the acute phase of rheumatic fever?
Nonspecific - eg fever and elevated ESR
S aureus
Myocarditis
Open blocked vessels

5. What coronary artery supplies the mitral valve papillary muscles?
RCA
Squatting - expiration
Asymptomatic
4-7 days macrophage infiltration

6. At what point in development do congenital heart defects arise?
Mitral mitral+aortic
3-8 wks
Boot shaped heart
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

7. What congenital heart defect often is present with infantile coarctation of the aorta?
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
Large vegetations of S aureus
PDA
LAD

8. What are heart failure cells?
Tetralogy of fallot
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Hemosiderin laden macrophages

9. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
4-7 days macrophage infiltration
Hemosiderin laden macrophages
Ventricular arrhythmia

10. What is cardiogenic shock?
Systolic ejection click followed by crescendo - decrescendo murmur
Prophylactic abx during dental procedures
Inability to maintain systemic pressure w/lack of O2 to vital organs
Backward LHF pulm htn and RHF - afib and associated mural thombis

11. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Maternal diabetes
Bounding pulse
Large - destructive vegetations

12. What drug relieves stable angina?
Prophylactic abx during dental procedures
Nitroglycerin
Ehlers - Danlow and Marfan syndrome
Migratory polyarthritis

13. What is the murmur of mitral regurg?
RCA
S epidermidis
Right to left
Holosystolic blowing murmur

14. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Colon cancer
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

15. What is an Aschoff body?
Dilated
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Paradoxical emboli
Ostium secundum (90%)

16. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Bounding pulse
IV drug users
ASD - R-->L

17. What structures are susceptible to rupture post MI?
Papillary muscle - free wall - IV septum
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Mitral regurg

18. What is the most comon cause of aortic regurg? What are the other causes?
Heart transplant
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

19. What increases the volume of mitral regurg murmur?
Myxoid degeneration
Myxoma - benign
Trisomy 21
Squatting - expiration

20. What is the tx for LHF?
VSD
ACE inhibitor
Myocarditis
Reperfusion injury

21. What are the sx of right - to - left shunt?
Rhadbomyoma - benign
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Cyanosis - RV hypertrophy - polycythemia - clubbing
Rupture of free wall - IV septum - or papillary muscle

22. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Volume overload and LHF
20 min
Mitral mitral+aortic

23. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Aneurysm - mural thrombus - Dressler syndrome
Endocardial fibroelastosis
S aureus

24. What compensatory mechanism do tetralogy of fallot pts learn?
Split S2 on auscultation
Squat in response to cyanotic spell
Anitschow cell
S aureus

25. How do nitrates tx MI?
L->R
Right -->left
Decrease preload -->lowers myocardial stress
LA dilation

26. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Mitral mitral+aortic
Shunt
Louder - increased systemic resistence decreases LV emptying
ST- segment elevation

27. How does asprin/heparin tx MI?
Group A beta - hemolytic streptococci
Myofiber hypertrophy with disarray
Limits thrombosis
Infantile coarctation of the aorta

28. What are the complications of mitral stenosis?
Large vegetations of S aureus
PDA
Months out fibrosis
Backward LHF pulm htn and RHF - afib and associated mural thombis

29. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Valve replacement
Regurg vs stenosis
Limits thrombosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

30. When do troponin levels rise - peak - and return to normal?
Ehlers - Danlow and Marfan syndrome
4-7 days macrophage infiltration
Dilated
2-4 hours - 24 hours - 7-10 days

31. What are the major criteria of the Jones criteria?
Stretched muscle loses contractility
Chronic ischemic heart disease
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

32. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ventricle
Heart can't fill
Hypercoagulable state or underlying adenocarcinoma

33. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Pulsating nail bed
Ischemic heart disease
Pericarditits

34. What causes the nutmeg color in nutmeg liver?
Congested central veins
Ventricles cannot pump
Prophylactic abx during dental procedures
Decreased forward perfusion pulmonary congestion

35. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Autoimmune pericarditis 6-8 wks post MI
Pericardial effusion due to pericardial involvement
Opening snap followed by diastolic rumble

36. What % of MIs involve the LAD?
Volume overload and LHF
45%
R-->L
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

37. What is the only Jones criteria that doesn't resolve with time?
4-6 hours - 24 hours - 72 hours
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Pancarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

38. What is the definition of ischemia?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Annular - non pruritic rash w/erythematous borders trunks and limbs
Decrease in blood flow to an organ
Metastasis

39. In which chamber of the heart are cardiac myxomas found?
LA
Annular - non pruritic rash w/erythematous borders trunks and limbs
Sterile vegetations on mitral valve along lines of closure
Surgical closure small defects may close spontaneously

40. What are the clinical features of RHF?
Tender lesions on fingers or toes.
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Endocarditis of prosthetic valves
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

41. Is scar tissue or myocardium stronger?
2-3 weeks
Myocardium
IV drug users
Gelatinous - abundant ground substance

42. What are the minor critera of the Jones criteria?
Reversible
Nonspecific - eg fever and elevated ESR
Fetal alcohol syndrome
Acute inflammation

43. What is the 1day-1wk -1mo mneumonic for MI?
Yellow pallor neutrophils
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Systemic venous congestion
Day 1-7

44. What is migratory polyarthritis?
S aureus
Spontaneous
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

45. What causes an early - blowing diastolic murmur?
Aortic regurg
Bicuspid aortic valve
Left -->right
Indomethacin - decreases PGE

46. Dilated cardiomyopathy is a late complication of what illness?
Migratory polyarthritis
Large vegetations of S aureus
Myocarditis
Decreases LV dilation by decreasing volume

47. What is the tx for mitral valve prolapse?
CHF
Reperfusion injury
Valve replacement
Maternal diabetes

48. How does squating decrease hypoxemia in tetralogy of fallot?
Open blocked vessels
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Prinzmetal stable and unstable
Low voltage EKG w/diminished QRS amplitude

49. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
1-3 days
S epidermidis
Subendocardial

50. What are the two effects of ATII?
Increased hydrostatic pressure
Mitral stenosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy