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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 % of MIs involve the LAD?
45%
RCA
Rhadbomyoma - benign
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

2. What type of shunt does a VSD cause?
L->R
LA dilation
Tetralogy of fallot
Pedunculated mass in the LA that causes syncope due to obstruction of MV

3. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
RHF
Eisenmenger syndrome
Loeffler syndrome
LA dilation

4. What is the characteristic murmurr of mitral stenosis?
Regurg vs stenosis
Mitral and tricuspid regurg - arrhythmia
Opening snap followed by diastolic rumble
Mitral insufficiency

5. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Mitral valve prolapse
Adult coarctation of the aorta
3-8 wks

6. What are the cancers that most commonly metastasize to the heart?
CHF
Coexisting mitral stenosis and fusion of commisures exist
Osler nodes (ouch - ouch Osler)
Breast and lung carcinoma - melanoma - lymphoma

7. What is the murmur of mitral valve prolapse?
Months out fibrosis
Wear and tear
PDA
Mid - systolic click followed by regurgitation murmur

8. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LHF
Mitral stenosis
PDA

9. What type of shunt does ASD cause?
PDA
First 4 hours
Left -->right
2-4 hours - 24 hours - 7-10 days

10. What is typically the mechanims of sudden cardiac death?
LAD
Ventricular arrhythmia
Systemic venous congestion
Reversible

11. What is an Aschoff body?
Maternal diabetes
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Posterior wall of LV - posterior septum - papillary muscles
S epidermidis

12. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
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
Myofiber hypertrophy with disarray
Reperfusion injury
Rhadbomyoma - benign

13. What does rupture of the LV free wall cause?
Increased blood in right heart delays closure of P valve
Cardiac tamponade
Streptococcus bovis/
2-4 hours - 24 hours - 7-10 days

14. What is the most common cause of infectious endocarditis?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Streptococcus viridans
Libman - Sacks endocarditis
Autoimmune pericarditis 6-8 wks post MI

15. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Friction rub and chest pain
Squat in response to cyanotic spell
Aortic regurg

16. What % stenosis causes stable angina?
PDA
Tuberous sclerosis
Sterile vegetations on surface and undersurface on mitral valve
>70%

17. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Sterile vegetations on surface and undersurface on mitral valve
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Ehlers - Danlow and Marfan syndrome

18. What is eythema marginatum? What parts of the body does it commonly involve?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Annular - non pruritic rash w/erythematous borders trunks and limbs
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ventricular arrhythmia

19. What causes wear and tear aortic stenosis?
Subendocardial
Fibrosis and dystrophic calcification
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LHF

20. With what disease is infantile coarctation of the aorta associated?
Myocardium
Turner syndrome
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

21. With what condition are rhabdomyomas associated?
4-24 hours
Decrease preload -->lowers myocardial stress
Ischemic heart disease
Tuberous sclerosis

22. What is the most common cause of endocarditis in IV drug users?
Mitral valve prolapse
S aureus
Fetal alcohol syndrome
Decreases LV dilation by decreasing volume

23. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
20 min
Infectious endocarditis - arrythmias - severe mitral regurg no

24. Ostium primum ASD is associated with what congenital disorder?
Decrease in blood flow to an organ
Kawasaki disease
Trisomy 21
Rhabdomyoma

25. Myofiber hypertrophy with disarray.
Myocarditis in acute rheumatic heart fever
Nitroglycerin
Hypertrophic cardiomyopathy
Chronic rheumatic heart disease

26. EKG for stable angina?
Aneurysm - mural thrombus - Dressler syndrome
>60 years - bicuspid aortic valve
ST- segment depression
Hypercoagulable state or underlying adenocarcinoma

27. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Chronic ischemic heart disease
45%
Nonbacterial thrombotic endocarditis (marantic endocarditis)

28. What is chronic rheumatic heart disease?
4-24 hours
Reperfusion injury
Volume overload and LHF
Valve scarring that arises as a consequence of rheumatic fever

29. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
>70%
Stable angina
PDA

30. What effect does transposition of the great vessels have on the ventricles?
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
Hypertophy of RV atrophy of LV
Myxoid degeneration
Paradoxical emboli

31. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Colon cancer
LAD
Limits thrombosis

32. What is the rate of congenital heart defects?
1%
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Pump failure
Heart transplant

33. Large vegetations on tricuspid valve?
Trisomy 21
Ventricle
MI
S aureus

34. What vavular defect results from acute rheumatic fever?
Sterile vegetations on surface and undersurface on mitral valve
Plump fibroblasts - collagen - blood vessels
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Mitral regurgitation due to vegetations

35. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
PDA
MI
Infectious endocarditis - arrythmias - severe mitral regurg no
PDA

36. What causes angina and syncope in aortic stenosis?

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37. What is Loeffler syndrome?
Tetralogy of fallot
Transposition of the great vessels
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Day 1-7

38. What is a water - hammer pulse?
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
Bounding pulse
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Decrease in blood flow to an organ

39. What is the most common cause of myocarditis?
Heart can't fill
Congenital rubella
Maternal diabetes
Coxsackie A or B

40. 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
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Maternal diabetes
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

41. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
ST- segment depression
Squat in response to cyanotic spell
Plump fibroblasts - collagen - blood vessels

42. What does chronic ischemic heart disease progress to?
CHF
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
2-3 weeks
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

43. What is Dressler syndrome? When does it occur?
Squat in response to cyanotic spell
Split S2 on auscultation
Pts w/previously damaged valves
Autoimmune pericarditis 6-8 wks post MI

44. What are complications of dilated cardiomyopathy?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Endocardial fibroelastosis (rare)
Mitral and tricuspid regurg - arrhythmia

45. How does transmural MI/ischemia present on EKG?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
ST- segment elevation
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Months out fibrosis

46. How long after pharyngitis does acute rheumatic fever occur?
Squatting - increased systemic resistence decreases LV emptying
Months out fibrosis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
2-3 weeks

47. With what disease is Libman - Sacks endocarditis associated?
Paradoxical emboli
SLE
>70%
Myocardium

48. What causes acute endocarditis?
Large vegetations of S aureus
Decreases LV dilation by decreasing volume
Transesophageal echo
Volume overload and LHF

49. What are the causes of restrictive cardiomyopathy in adults?
S viridans
Mitral insufficiency
Cardiac tamponade
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

50. Holosystolic blowing murmur that increases w/expiration?
First 4 hours
Mitral regurg
White scar fibrosis
Cardiogenic shock - CHF - arrhythmia