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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 the major cause of MI?
RCA
Transposition of the great vessels
S aureus
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

2. What effect does chronic rheumatic heart disease have on the aortic valve?

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3. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Hypercoagulable state or underlying adenocarcinoma
Slow HR - decreasing O2 demand and risk for arrhythmia
Aortic regurg
Reperfusion injury

4. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Transesophageal echo
Chronic ischemic heart disease
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

5. What congenital heart defect presents later in life with lower extremity cyanosis?
Day 1-7
PDA
Chest pain <20 min brought on by exertion or emotional stress
2-4 hours - 24 hours - 7-10 days

6. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Indomethacin - decreases PGE
Infectious endocarditis - arrythmias - severe mitral regurg no
Cardiac tamponade

7. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Mitral stenosis
Ehlers - Danlow and Marfan syndrome
Coxsackie A or B
Loeffler syndrome

8. With what disease is transposition of the great vessels associated?
Maternal diabetes
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
ACE inhibitor
Rupture of free wall - IV septum - or papillary muscle

9. What causes heart failure cells?
Circumflex
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral regurg
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

10. What are the two effects of ATII?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Bacterial endocarditis
Dilation of all four chambers of the heart
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

11. What type of ischemia does stable angina cause?
Chest pain <20 min brought on by exertion or emotional stress
Mitral insufficiency
Subendocardial
2-4 hours - 24 hours - 7-10 days

12. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Transposition of the great vessels

13. What type of valvular vegetations does S aureus cause?
Left -->right
Large - destructive vegetations
Hypertrophic cardiomyopathy
Intercostal arteries enlarged due to collateral circulation

14. Tender lesions on fingers or toes.
VSD
Granulation tissue
Atherosclerosis of coronary arteries
Osler nodes (ouch - ouch Osler)

15. What is the most common type of endocarditis?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
ST- segment depression
Infectious
4-6 hours - 24 hours - 72 hours

16. What is diastolic dysfx?
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
Eisenmenger syndrome
Inability to fill ventricles
Congested central veins

17. What endocarditis is commonly found in patients with colon cancer?
Stable and unstable prinzmetal
Streptococcus bovis/
Metastasis
2-3%

18. What is the main cause of MV regurg? What are other causes?
ACE inhibitor
PDA
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

19. What are the cancers that most commonly metastasize to the heart?
Sterile vegetations on surface and undersurface on mitral valve
Louder - increased systemic resistence decreases LV emptying
Sterile vegetations on mitral valve along lines of closure
Breast and lung carcinoma - melanoma - lymphoma

20. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Fibrosis and dystrophic calcification
Migratory polyarthritis
Circumflex

21. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myofiber hypertrophy with disarray
Pump failure
ACE inhibitor
Myxoma - benign

22. When does the heart have dark discoloration post MI?
Mitral and tricuspid regurg - arrhythmia
1-3 days out
4-24 hours
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

23. Vegetations on surface and undersurface of mitral valve.
Rhadbomyoma - benign
Libman - Sacks endocarditis
Reversible
Blood vessels coming in from normal tissue

24. How does restrictive cardiomyopathy present?
Minimizes ischemia
Congestive heart failure
Mitral mitral+aortic
ST- segment depression

25. What type of endocarditis is associated with SLE?
LAD
Red border granulation tissue
Split S2 on auscultation
Libman - Sacks endocarditis

26. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Troponin I
Valve replacement AFTER the onset of complications
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

27. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Restrictive cardiomyopathy
Ventricles cannot pump

28. What are other (not atherosclerotic) causes of MI?
Nitroglycerin
Squatting - expiration
45%
Coronary artery vasospasm - emboli - vasculitis

29. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Infectious endocarditis - arrythmias - severe mitral regurg no
1%
Hypercoagulable state or underlying adenocarcinoma

30. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Yellow pallor neutrophils
Tuberous sclerosis
Nitroglycerin
Left -->right

31. What are the causes of LHF?
Stable angina
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Asymptomatic
>70%

32. What is the most common cause of endocarditis in IV drug users?
S aureus
Systolic ejection click followed by crescendo - decrescendo murmur
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Hypercoagulable state or underlying adenocarcinoma

33. What is the only Jones criteria that doesn't resolve with time?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pancarditis
LAD
4-24 hours

34. What gross and microscopic changes occur 1-3 days after an MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Yellow pallor neutrophils
20 min
Papillary muscle - free wall - IV septum

35. What gross and microscopic changes occur 1-3 weeks after an MI?
2-4 hours - 24 hours - 7-10 days
Myocarditis
Red border granulation tissue
VSD

36. What increases the risk for chronic rheumatic heart disease?
R-->L
Myxoma - benign
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
S aureus

37. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Heart transplant
Tetralogy of fallot
Group A beta - hemolytic streptococci

38. What are the sx of pericardiits?
Tuberous sclerosis
Friction rub and chest pain
Coxsackie A or B
Small - nondestructive vegetations (subacute endocarditis)

39. How does ischemia cause LHF?
PGE
Loss of fx
Myocarditis in acute rheumatic heart fever
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

40. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Friction rub and chest pain
Months out fibrosis
Left -->right

41. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LHF
Myofiber hypertrophy with disarray
Pedunculated mass in the LA that causes syncope due to obstruction of MV

42. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Squatting - expiration
Infantile coarctation of the aorta PDA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Stable and unstable prinzmetal

43. Which angina(s) show ST elevation on EKG? ST depression?
LV dilation and eccentric hypertrophy
Prinzmetal stable and unstable
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
Systolic ejection click followed by crescendo - decrescendo murmur

44. What type of shunt does truncus arteriosus cause?
Sterile vegetations on mitral valve along lines of closure
R-->L
PDA
LV dilation and eccentric hypertrophy

45. What causes notching of the ribs in adult coarctation of the aorta?
RCA
Intercostal arteries enlarged due to collateral circulation
Infectious
Increased blood in right heart delays closure of P valve

46. Ostium primum ASD is associated with what congenital disorder?
Low voltage EKG w/diminished QRS amplitude
Prinzmetal stable and unstable
Trisomy 21
Cardiac tamponade

47. What type of vegetations are associated with Libman - Sacks endocarditis?
3-8 wks
MI
Opening snap followed by diastolic rumble
Sterile vegetations on surface and undersurface on mitral valve

48. What are the tx for MI?
Breast and lung carcinoma - melanoma - lymphoma
Tuberous sclerosis
Ostium primum
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

49. What artery is the 2nd most often occluded in an MI?
RCA
Loss of fx
Coexisting mitral stenosis and fusion of commisures exist
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

50. What is the most common congenital heart defect?
VSD
Right side - serotonin and other secretory products detoxified in the lung
Thickening of chrodae tendinae and cusps - mitral stenosis
Systemic venous congestion