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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 characterizes acute rheumatic fever endocarditiis?
Myxoid degeneration
Small vegetations along the line of closure
Holosystolic machine like murmur
Chest pain <20 min brought on by exertion or emotional stress

2. How does hypertension cause LHF?

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3. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Opening snap followed by diastolic rumble
Months out fibrosis
Circumflex
Aschoff bodies

4. What coronary artery supplies the mitral valve papillary muscles?
Mitral regurg
Fetal alcohol syndrome
Metastasis
RCA

5. What is the rate of mitral valve prolapse in the US?
Infectious endocarditis - arrythmias - severe mitral regurg no
Group A beta - hemolytic streptococci
Libman - Sacks endocarditis
2-3%

6. What effect does transposition of the great vessels have on the ventricles?
Tender lesions on fingers or toes.
Hypertophy of RV atrophy of LV
Degree of pulmonary artery stenosis
Months out fibrosis

7. What effect does dilated cardiomyopathy have on the heart?
Tricuspid
Shunt
Ventricles cannot pump
Systolic dysfx leading to biventricular CHF

8. What are the clinical features of LHF due to?
S aureus
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
Decreased forward perfusion pulmonary congestion

9. What is the etiology of S viridans endocarditis?
Coexisting mitral stenosis and fusion of commisures exist
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Shunt - PGE to maintain PDA until surgical repair can be performed

10. What iis the tx for aortic regurg?
Decreases LV dilation by decreasing volume
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Valve replacement once LV dysfx develops
ACE inhibitor

11. Why are cardiac enzymes elevated after an MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Indomethacin - decreases PGE
Ventricles cannot pump
Membrane damage

12. What side of the heart do carcinoid tumors affect? Why?
Harmartoma
Ehlers - Danlow and Marfan syndrome
Right side - serotonin and other secretory products detoxified in the lung
>60 years - bicuspid aortic valve

13. Tender lesions on fingers or toes.
PGE
Restrictive cardiomyopathy
Osler nodes (ouch - ouch Osler)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

14. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Friction rub and chest pain
Congenital rubella
PDA

15. What is dilated cardiomyopathy?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Dilation of all four chambers of the heart
Dressler syndrome
PDA

16. How does transmural MI/ischemia present on EKG?
>60 years - bicuspid aortic valve
Chest pain <20 min brought on by exertion or emotional stress
ST- segment elevation
Pts w/previously damaged valves

17. What endocarditis is commonly found in patients with colon cancer?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Streptococcus bovis/
Rhadbomyoma - benign
Prinzmetal angina - cocaine

18. What are the clinical features of RHF due to?
Myxoid degeneration
Systemic venous congestion
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
S aureus

19. What is eythema marginatum? What parts of the body does it commonly involve?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Anitschow cell
Annular - non pruritic rash w/erythematous borders trunks and limbs
Heart transplant

20. What are other (not atherosclerotic) causes of MI?
Small vegetations along the line of closure
Coronary artery vasospasm - emboli - vasculitis
MI
Circumflex

21. At what point in development do congenital heart defects arise?
Reversible
3-8 wks
Atria and RV
Reperfusion injury

22. What are the clinical features of RHF?
Prinzmetal angina - cocaine
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Sterile vegetations on mitral valve along lines of closure
Hypertophy of RV atrophy of LV

23. What is a common complication of cardiac metastasis?
Decreased forward perfusion pulmonary congestion
Erythematous nontender lesions on palms and soles.
Papillary muscle - free wall - IV septum
Pericardial effusion due to pericardial involvement

24. How does squating decrease hypoxemia in tetralogy of fallot?
VSD
Split S2 on auscultation
CHF
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

25. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Anitschow cell
Split S2 on auscultation
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

26. What is the most common congenital heart defect?
VSD
Pericarditits
Degree of pulmonary artery stenosis
Rhadbomyoma - benign

27. What causes endocarditis of prosthetic valves?
Boot shaped heart
S epidermidis
Mitral regurg
Coxsackie A or B

28. What causes an early - blowing diastolic murmur?
Aortic regurg
Valve scarring that arises as a consequence of rheumatic fever
Pancarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

29. What does rupture of a papillary muscle cause?
Cardiac tamponade
Mitral insufficiency
Valve replacement once LV dysfx develops
Sterile vegetations on mitral valve along lines of closure

30. Is injury due angina reversible or irreversible?
Endocardial fibroelastosis (rare)
Reversible
RCA
R-->L

31. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Wear and tear
Yellow pallor neutrophils
Nonbacterial thrombotic endocarditis (marantic endocarditis)

32. How does reperfusion injury occur?
Dilated
Libman - Sacks endocarditis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Elevated ASO anti - DNase B titers

33. What are the cancers that most commonly metastasize to the heart?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Positive blood cultures anemia of chronic disease
Breast and lung carcinoma - melanoma - lymphoma
Degree of pulmonary artery stenosis

34. What is the murmur of mitral valve prolapse?
Maternal diabetes
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mid - systolic click followed by regurgitation murmur
Pericarditits

35. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Metastasis
Thickening of chrodae tendinae and cusps - mitral stenosis
Reactive histiocyte with caterpillar nucleus

36. What type of endocarditis is associated with SLE?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
R-->L
Libman - Sacks endocarditis

37. What is a complication of chronic rheumatic heart disease?
PDA
Yellow pallor macrophages
Positive blood cultures anemia of chronic disease
Infectious endocarditis

38. What is the most common type of ASD? What %?
Ostium secundum (90%)
S aureus
LA dilation
Degree of pulmonary artery stenosis

39. What is systolic dysfx?
Shunt - PGE to maintain PDA until surgical repair can be performed
Ventricles cannot pump
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

40. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Valve replacement AFTER the onset of complications
Squatting - expiration
Streptococcus viridans

41. What are the major criteria of the Jones criteria?
Right to left
Increased blood in right heart delays closure of P valve
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Small - nondestructive vegetations (subacute endocarditis)

42. What cardiac disease is associated with tuberous sclerosis?
Tuberous sclerosis
PDA
Rhabdomyoma
Hypertophy of RV atrophy of LV

43. What increases the volume of mitral regurg murmur?
Squatting - expiration
Congestive heart failure
Ostium primum
Decrease in blood flow to an organ

44. What is the tx for aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Preductal - post aortic arch
Mitral mitral+aortic
Valve replacement AFTER the onset of complications

45. What are the sx of hypertrophic cardiomyopathy?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
L->R
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

46. What gross and microscopic changes occur 4-7 days after an MI?
VSD
Dilation of all four chambers of the heart
Yellow pallor macrophages
Adult coarctation of the aorta

47. What bug causes acute rheumatic fever?
Pts w/previously damaged valves
Infectious
Congestive heart failure
Group A beta - hemolytic streptococci

48. What effect does aortic regurg have on the pulse pressure? Why?
LV dilation and eccentric hypertrophy
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Asymptomatic

49. What is the cause of restrictive cardiomyopathy in children?
Streptococcus viridans
Pts w/previously damaged valves
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
Endocardial fibroelastosis (rare)

50. What is the most common tumor of the heart?
Nitroglycerin
Metastasis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Atria and RV