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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 characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
LAD
Fibrosis and dystrophic calcification
Rhabdomyoma

2. What effect does aortic regurg have on the pulse pressure? Why?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Asymptomatic
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral mitral+aortic

3. What complication occurs 1-3 days post MI?
RCA
Ehlers - Danlow and Marfan syndrome
Ventricles cannot pump
Fibrinous pericarditis

4. What drug relieves stable angina?
Stable angina
Loss of LV fx
Erythematous nontender lesions on palms and soles.
Nitroglycerin

5. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
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
Backward LHF pulm htn and RHF - afib and associated mural thombis
Prinzmetal angina
Aortic regurg

6. What are the complications that occur months after an MI?
4-6 hours - 24 hours - 72 hours
Kawasaki disease
Aneurysm - mural thrombus - Dressler syndrome
S epidermidis

7. What complications occur 4-7 days post MI?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Anitschow cell
Rupture of free wall - IV septum - or papillary muscle
Myocarditis

8. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
ST- segment elevation
Increased hydrostatic pressure
Coxsackie A or B

9. What is the murmur of mitral valve prolapse?
Myxoid degeneration
Mid - systolic click followed by regurgitation murmur
Surgical closure small defects may close spontaneously
Mitral valve prolapse

10. What causes the split S2 in ASD?
CK- MB
Surgical closure small defects may close spontaneously
Increased blood in right heart delays closure of P valve
LHF

11. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Bicuspid aortic valve
Rhabdomyoma
NG or Ca channel blocker

12. What type of ASD is associated w/Down syndrome?
AD mutation in sarcomere proteins
Ostium primum
Dense layer of elastic and fibrotic tissue in the endocardium - children
Left -->right

13. What are the laboratory findings of bacterial endocarditis?
Stretched muscle loses contractility
Endocardial fibroelastosis
Indomethacin - decreases PGE
Positive blood cultures anemia of chronic disease

14. What are the cancers that most commonly metastasize to the heart?
Metastasis
Sterile vegetations on surface and undersurface on mitral valve
Dense layer of elastic and fibrotic tissue in the endocardium - children
Breast and lung carcinoma - melanoma - lymphoma

15. Is injury due angina reversible or irreversible?
Reversible
Adult coarctation of the aorta
Right side - serotonin and other secretory products detoxified in the lung
Pancarditis

16. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Squat in response to cyanotic spell
Reversible
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

17. What cardiac disease is associated with tuberous sclerosis?
Boot shaped heart
Rhabdomyoma
Mitral mitral+aortic
Months out fibrosis

18. What are Janeway lesions?
Months out fibrosis
RCA
Erythematous nontender lesions on palms and soles.
Valve replacement once LV dysfx develops

19. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Hemosiderin laden macrophages
1%
Pts w/previously damaged valves

20. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral stenosis
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
Rhabdomyoma

21. What is the cause of restrictive cardiomyopathy in children?
Infantile coarctation of the aorta PDA
Kawasaki disease
Dense layer of elastic and fibrotic tissue in the endocardium - children
Endocardial fibroelastosis (rare)

22. How does squating decrease hypoxemia in tetralogy of fallot?
Opening snap followed by diastolic rumble
Elevated ASO anti - DNase B titers
PGE
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

23. What is typically the mechanims of sudden cardiac death?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Ventricular arrhythmia
Turner syndrome
Anterior wall of LV and anterior septum

24. What is the characteristic finding on CXR in tetralogy of fallot?
Ostium primum
PDA
Plump fibroblasts - collagen - blood vessels
Boot shaped heart

25. What are the sx of right - to - left shunt?
L->R
Thickening of chrodae tendinae and cusps - mitral stenosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Tender lesions on fingers or toes.

26. What is the leading cause of death in the US?
Ischemic heart disease
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Pump failure
Doxorubicin - cocaine

27. What is migratory polyarthritis?
Blood vessels coming in from normal tissue
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Stable and unstable prinzmetal
Reversible

28. In which chamber of the heart are rhabdomyomas found?
Systemic venous congestion
Opening snap followed by diastolic rumble
White scar fibrosis
Ventricle

29. How does asprin/heparin tx MI?
Limits thrombosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
RBC damaged while crossing the calcified valve causing schistocytes
2-3 weeks

30. When do CK- MB levels rise - peak - and return to normal?
Anterior wall of LV and anterior septum
Ventricles cannot pump
4-6 hours - 24 hours - 72 hours
LA

31. In which chamber of the heart are cardiac myxomas found?
Migratory polyarthritis
LA
Aschoff bodies
Cardiac tamponade

32. L- to - R shunt switching to R- to - L shunt.
Decrease preload -->lowers myocardial stress
Eisenmenger syndrome
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Hypertrophic cardiomyopathy

33. When do neutrophils infiltrate the myocardium post MI?
Congenital rubella
LHF
Valve scarring that arises as a consequence of rheumatic fever
1-3 days

34. What valves are most commonly involved in chronic rheumatic heart disease?
S aureus
Mitral mitral+aortic
Gelatinous - abundant ground substance
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

35. What is the most common cause of myocarditis?
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
Coxsackie A or B
Loss of fx
Hemosiderin laden macrophages

36. When does the heart have dark discoloration post MI?
Nonspecific - eg fever and elevated ESR
LAD
Mitral mitral+aortic
4-24 hours

37. What heart sound manifest with an ASD?
Split S2 on auscultation
Yellow pallor neutrophils
Decrease preload -->lowers myocardial stress
Ischemic heart disease

38. What congenital heart defect is associated with fetal alcohol syndrome?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
VSD
Dilation of all four chambers of the heart
LAD

39. What makes the MV prolapse murmur louder? Why?
Spontaneous
Decrease in blood flow to an organ
Squatting - increased systemic resistence decreases LV emptying
Systolic ejection click followed by crescendo - decrescendo murmur

40. What areas of the heart does the RCA supply?
Reperfusion injury
Yellow pallor macrophages
Posterior wall of LV - posterior septum - papillary muscles
Nitroglycerin

41. How do nitrates tx MI?
Aschoff bodies
Decrease preload -->lowers myocardial stress
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

42. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Infectious endocarditis - arrythmias - severe mitral regurg no
Tuberous sclerosis
Loss of LV fx

43. What conditions can cause nonbacterial thrombotic endocarditis?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral stenosis
Hypercoagulable state or underlying adenocarcinoma
Endocarditis of prosthetic valves

44. What gross and microscopic changes occur months after an MI?
White scar fibrosis
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
R-->L
Tricuspid

45. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Mitral mitral+aortic
Infantile coarctation of the aorta
LHF
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

46. What type of endocarditis is associated with SLE?
Nonspecific - eg fever and elevated ESR
Libman - Sacks endocarditis
Colon cancer
Regurg vs stenosis

47. What are the clinical features of RHF due to?
Systemic venous congestion
Stretched muscle loses contractility
Infectious
Increased hydrostatic pressure

48. What is chronic rheumatic heart disease?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
>70%
Valve scarring that arises as a consequence of rheumatic fever
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

49. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Troponin I
Chronic ischemic heart disease
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

50. How does dilated cardiomyopathy cause LHF?
When a bacterial protein resembles a protein in human tissue
Months out fibrosis
Stretched muscle loses contractility
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar