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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. When do troponin levels rise - peak - and return to normal?
S viridans
Infantile coarctation of the aorta PDA
2-4 hours - 24 hours - 7-10 days
Mitral regurg

2. What congenital heart defect often is present with infantile coarctation of the aorta?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Rhadbomyoma - benign
Endocardial fibroelastosis
PDA

3. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Infectious endocarditis - arrythmias - severe mitral regurg no
Decrease in blood flow to an organ
Prinzmetal stable and unstable
Aortic regurg

4. Low voltage EKG w/diminished QRS amplitude.
Aortic regurg
Valve replacement
Restrictive cardiomyopathy
Plump fibroblasts - collagen - blood vessels

5. Systolic ejection click followed by crescendo - decrescendo murmur.
Janeway lesions
Inability to maintain systemic pressure w/lack of O2 to vital organs
Turner syndrome
Aortic stenosis

6. What is the etiology of S viridans endocarditis?
Right -->left
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Yellow pallor neutrophils
Type I

7. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Ehlers - Danlow and Marfan syndrome
RBC damaged while crossing the calcified valve causing schistocytes
Opening snap followed by diastolic rumble

8. What does a biopsy of hypertrophic cardiomyopathy look like?
Valve scarring that arises as a consequence of rheumatic fever
Sterile vegetations on mitral valve along lines of closure
Posterior wall of LV - posterior septum - papillary muscles
Myofiber hypertrophy with disarray

9. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Large - destructive vegetations
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

10. Why are cardiac enzymes elevated after an MI?
PGE
Mitral mitral+aortic
Sudden cardiac death
Membrane damage

11. 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
Concentric LV hypertophy
Sudden cardiac death
Cardiogenic shock - CHF - arrhythmia

12. What is the characteristic murmur of aortic stenosis?
Atria and RV
Mitral mitral+aortic
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Systolic ejection click followed by crescendo - decrescendo murmur

13. With what disease is Libman - Sacks endocarditis associated?
Increased blood in right heart delays closure of P valve
Pump failure
1%
SLE

14. What is the cause of restrictive cardiomyopathy in children?
Dressler syndrome
Endocardial fibroelastosis (rare)
PDA
PDA

15. What is the characteristic murmurr of mitral stenosis?
Pericardial effusion due to pericardial involvement
Opening snap followed by diastolic rumble
VSD
Decreases LV dilation by decreasing volume

16. What causes unstable angina?
Tetralogy of fallot
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
2-4 hours - 24 hours - 7-10 days
S aureus

17. What is the 1day-1wk -1mo mneumonic for MI?
RBC damaged while crossing the calcified valve causing schistocytes
Tetralogy of fallot
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Months out fibrosis

18. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Myocarditis in acute rheumatic heart fever
PGE
Split S2 on auscultation

19. What causes a mid - systolic click followed by a regurgitation murmur?
Streptococcus bovis/
Mitral valve prolapse
Paradoxical emboli
LV dilation and eccentric hypertrophy

20. What type of shunt does ASD cause?
Spontaneous
Left -->right
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Prinzmetal angina - cocaine

21. What is the tx for LHF?
ACE inhibitor
Gelatinous - abundant ground substance
Months out fibrosis
4-24 hours

22. What are the clinical features of RHF due to?
Systemic venous congestion
Small - nondestructive vegetations (subacute endocarditis)
4-6 hours - 24 hours - 72 hours
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

23. What type of shunt does a VSD cause?
Hypercoagulable state or underlying adenocarcinoma
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Ostium secundum (90%)
L->R

24. What gross and microscopic changes occur 1-3 weeks after an MI?
Mitral regurg
Red border granulation tissue
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
2-3%

25. Which angina(s) show ST elevation on EKG? ST depression?
Fibrosis and dystrophic calcification
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
2-3%
Prinzmetal stable and unstable

26. What heart sound manifest with an ASD?
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
Chronic ischemic heart disease
First 4 hours
Split S2 on auscultation

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

28. What is the leading cause of death in the US?
Congested central veins
Ischemic heart disease
Granulation tissue
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

29. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Rupture of free wall - IV septum - or papillary muscle
Heart transplant
Fetal alcohol syndrome

30. What type of ASD is associated w/Down syndrome?
Ostium primum
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
Streptococcus viridans
AD mutation in sarcomere proteins

31. What is the most common cause of aortic stenosis?
Streptococcus viridans
Loss of LV fx
Wear and tear
Friction rub and chest pain

32. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Preductal - post aortic arch
Pericardial effusion due to pericardial involvement
Reperfusion injury

33. Holosystolic blowing murmur that increases w/expiration?
Harmartoma
MI
LHF
Mitral regurg

34. What causes heart failure cells?
Chronic rheumatic heart disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Migratory polyarthritis
Systemic venous congestion

35. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Libman - Sacks endocarditis
Myofiber hypertrophy with disarray
ASD - R-->L

36. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
ASD - R-->L
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pts w/previously damaged valves
Stable angina

37. How does Eisenmeger syndrome occur?
Streptococcus bovis/
Blood vessels coming in from normal tissue
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
RHF

38. What vavular defect results from acute rheumatic fever?
20 min
Squatting - increased systemic resistence decreases LV emptying
Plump fibroblasts - collagen - blood vessels
Mitral regurgitation due to vegetations

39. What genetic conditions predispose a pt to mitral valve prolapse?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ehlers - Danlow and Marfan syndrome
Decreased forward perfusion pulmonary congestion
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

40. What is dilated cardiomyopathy?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Friction rub and chest pain
Sterile vegetations on mitral valve along lines of closure
Dilation of all four chambers of the heart

41. What is the characteristic finding on CXR in tetralogy of fallot?
Myocardium
Boot shaped heart
Ischemic heart disease
Myxoid degeneration

42. What maintains patency of the PDA?
PGE
Streptococcus bovis/
Systolic dysfx leading to biventricular CHF
Breast and lung carcinoma - melanoma - lymphoma

43. In what pt population does S aureus commonly cause valvular disease?
LA
Left -->right
Friction rub and chest pain
IV drug users

44. With what disease is transposition of the great vessels associated?
Maternal diabetes
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Split S2 on auscultation

45. What type of collagen is involved in fibrosis?
Large - destructive vegetations
Spontaneous
Type I
Yellow pallor macrophages

46. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
S aureus
Small - nondestructive vegetations (subacute endocarditis)
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

47. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Volume overload and LHF
AD mutation in sarcomere proteins
Kawasaki disease

48. What causes an early - blowing diastolic murmur?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Trisomy 21
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aortic regurg

49. Is injury due angina reversible or irreversible?
Reversible
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Tuberous sclerosis
Hypertrophic cardiomyopathy

50. What murmur ccan be heard in PDA?
Reactive histiocyte with caterpillar nucleus
20 min
Preductal - post aortic arch
Holosystolic machine like murmur