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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. How do you prevent S viridans endocarditis?
When a bacterial protein resembles a protein in human tissue
Prophylactic abx during dental procedures
First 4 hours
LA

2. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
RHF
ASD - R-->L
LV dilation and eccentric hypertrophy
Months out fibrosis

3. What are the complications of mitral valve prolapse? Are they common?
Sudden cardiac death
Blood vessels coming in from normal tissue
Systolic dysfx leading to biventricular CHF
Infectious endocarditis - arrythmias - severe mitral regurg no

4. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Turner syndrome
Asymptomatic
Loss of fx

5. What type of shunt does a VSD cause?
L->R
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Ventricle
PGE

6. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Group A beta - hemolytic streptococci

7. What coronary artery supplies the mitral valve papillary muscles?
Holosystolic machine like murmur
Annular - non pruritic rash w/erythematous borders trunks and limbs
RCA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

8. What is Dressler syndrome? When does it occur?
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
Bounding pulse
Nitroglycerin
Autoimmune pericarditis 6-8 wks post MI

9. How does ischemia cause LHF?
PGE
Loss of fx
L->R
Prinzmetal stable and unstable

10. What is molecular mimicry?
1-3 days
When a bacterial protein resembles a protein in human tissue
Infectious endocarditis
AD mutation in sarcomere proteins

11. What causes notching of the ribs in adult coarctation of the aorta?
Hypertrophic cardiomyopathy
Infectious endocarditis
Intercostal arteries enlarged due to collateral circulation
Mitral regurgitation due to vegetations

12. How does MI cause LHF?
Dressler syndrome
Loss of LV fx
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Turner syndrome

13. What increases the risk for chronic rheumatic heart disease?
PDA
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Dilation of all four chambers of the heart
2-3%

14. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Degree of pulmonary artery stenosis
ST- segment depression
Mitral mitral+aortic

15. What does a biopsy of hypertrophic cardiomyopathy look like?
Decreased forward perfusion pulmonary congestion
Within the first day
Myofiber hypertrophy with disarray
Reactive histiocyte with caterpillar nucleus

16. What congenital heart defect does indomethacin tx?
Colon cancer
PDA
RCA
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

17. What is the effect of mitral regurg on the heart?
Prinzmetal
4-6 hours - 24 hours - 72 hours
Volume overload and LHF
Degree of pulmonary artery stenosis

18. What are other (not atherosclerotic) causes of MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Coronary artery vasospasm - emboli - vasculitis
Heart transplant
>60 years - bicuspid aortic valve

19. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Decrease preload -->lowers myocardial stress
Endocarditis of prosthetic valves
IV drug users

20. What cardiac disease is associated with tuberous sclerosis?
Cardiac tamponade
Mitral regurg
Rhabdomyoma
Metastasis

21. Pericarditis 6-8 wks post MI.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Months out fibrosis
Dressler syndrome
Ventricle

22. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
SLE

23. What effect does aortic stenosis have on the chambers of the heart?
LAD
Concentric LV hypertophy
Mitral mitral+aortic
Mitral regurg

24. What is diastolic dysfx?
Inability to fill ventricles
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Nonspecific - eg fever and elevated ESR
Yellow pallor neutrophils

25. What are the sx of right - to - left shunt?
>70%
Reperfusion injury
Cyanosis - RV hypertrophy - polycythemia - clubbing
Mitral and tricuspid regurg - arrhythmia

26. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Eisenmenger syndrome
Contraction band necrosis - reperfusion injury

27. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Congestive heart failure
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Autoimmune pericarditis 6-8 wks post MI

28. What are Osler nodes?
Months out fibrosis
Congenital rubella
S aureus
Tender lesions on fingers or toes.

29. What is the definition of ischemia?
Maternal diabetes
Decrease in blood flow to an organ
R-->L
Squat in response to cyanotic spell

30. What disesase has Aschoff bodies?
Prinzmetal
Myocarditis in acute rheumatic heart fever
Right side - serotonin and other secretory products detoxified in the lung
IV drug users

31. Friction rub and chest pain.
Pericarditits
Dilation of all four chambers of the heart
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Prophylactic abx during dental procedures

32. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Inability to fill ventricles
Contraction band necrosis

33. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Shunt - PGE to maintain PDA until surgical repair can be performed
Holosystolic blowing murmur
Coexisting mitral stenosis and fusion of commisures exist
Paradoxical emboli

34. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
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
ASD - R-->L
RCA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

35. What is the rate of congenital heart defects?
1%
Hemosiderin laden macrophages
Systolic ejection click followed by crescendo - decrescendo murmur
NG or Ca channel blocker

36. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Contraction band necrosis
Systolic ejection click followed by crescendo - decrescendo murmur
Within the first day

37. How does hypertension cause LHF?

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38. How does restrictive cardiomyopathy cause LHF?

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39. What causes unstable angina?
Janeway lesions
Systolic ejection click followed by crescendo - decrescendo murmur
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

40. What is the most common tumor of the heart?
Metastasis
LV dilation and eccentric hypertrophy
Loss of fx
Positive blood cultures anemia of chronic disease

41. What are the four defects in tetralogy of fallot?
3-8 wks
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral regurgitation due to vegetations

42. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Rupture of free wall - IV septum - or papillary muscle
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Transposition of the great vessels

43. What type of shunt dose PDA cause?
Migratory polyarthritis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Left -->right
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

44. Vegetations on surface and undersurface of mitral valve.
Mitral insufficiency
2-4 hours - 24 hours - 7-10 days
Months out fibrosis
Libman - Sacks endocarditis

45. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
3-8 wks
Holosystolic machine like murmur
Heart transplant

46. Which coronary artery supplies the anterior wall and anterior septum?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
LAD
Reperfusion injury
Left -->right

47. What effect does transposition of the great vessels have on the ventricles?
Spontaneous
Doxorubicin - cocaine
Coxsackie A or B
Hypertophy of RV atrophy of LV

48. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Ischemic heart disease
Coronary artery vasospasm - emboli - vasculitis
Pts w/previously damaged valves

49. Ostium primum ASD is associated with what congenital disorder?
Right to left
Volume overload and LHF
Trisomy 21
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

50. What are the causes of LHF?
Aortic regurg
Months out fibrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Squatting - expiration